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{{#seo:

|title=Gulma Chikitsa

|titlemode=append

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|keywords=Gulma (abdominal lumps), Pathya (whole some), Rakta Mokshana (bloodletting), Apathya (unwholesome)

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|keywords=Gulma (abdominal lumps), Pathya (whole some), Rakta Mokshana (bloodletting), Apathya (unwholesome), Ayurveda, charak samhita, Indian system of medicine.

|description=Chikitsa Sthana Chapter 5.Management of Gulma(abdominal lumps and other diseases)

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|image=http://www.carakasamhitaonline.com~~/mediawiki-1.32.1~~/resources/assets/ogimgs.jpg

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=charak samhita

|type=article

}}

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<big>'''[[Chikitsa Sthana]] Chapter 5.Management of Gulma '''</big>

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

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~~<div style="text-align:justify;">~~

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''Gulma'' is defined as large palpable, rounded, intra- abdominal swellings between ''hridaya'' (cardiac region) and the ''basti'' (bladder) regions, which develop due to excess accumulation of ''doshas'' with predominance of ''vata''. Such swellings are either transitory or static, and display the properties of spontaneous regression and reappearance. This chapter on the treatment of ''gulma'' (abdominal lumps) first describes its general etiological factors and pathogenesis along with five places in the abdomen where the swelling occurs. The treatment of ''vata gulma'' includes ''snehana'' (oleation), ''swedana'' (sudation), ''brimhana'' (repletion), ''basti'' with ''ghee'', ''virechana'', ''vamana'' and preparations in the form of powders, pills and medicated ''ghrita'' and as a last resort bloodletting. For the treatment of ''pitta gulma'', the ''ghrita'' prepared with bitter (''tikta'') drugs, ''virechana'', recipes for ''niruha basti'', blood-letting (''rakta-mokshana''), use of milk, counseling (''ashvasana'') and oral recipes have been elaborated. ''Upanaha'' (poultice), ''shodhana'' and surgical measures for suppurated and internally ruptured ''gulma'' have also been described.

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For ''kapha gulma snehana'', ''swedana'', ''bhedana'' (puncturing), ''langhana'' (lightening therapy), ''vamana'', ''virechana'', medicated ''ghee'', ''basti'', pills, powder, ''arishta'', and ''kshara'' are described. Bloodletting followed by cauterization of the ''gulma'' as a last resort is explained. A surgical procedure for ''rakta gulma'', which occurs only in women is also described.

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Wholesome (''pathya'') food and drinks, avoidance of etiological factors, continuous protection of digestive power (''agni'') and the instructions for a patient who undergoes ''snehana'' are discussed in detail.

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~~</div>~~

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~~'''Keywords''': ''Gulma'' (abdominal lumps), ''Pathya'' (whole some), ''Rakta Mokshana'' (bloodletting), ''Apathya'' (unwholesome)~~

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{{Infobox

|title = Gulma Chikitsa

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|label5 = Other Sections

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|data6 = Singh G.

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|label7 = Reviewer

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|data7 = Bhagwat M., Tripathi J.S., Gadgil D.

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|label8 = Editors

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|data8 = Baghel M.S., Deole Y.S., Basisht G.

+

|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.006 10.47468/CSNE.2020.e01.s06.006]

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}}

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

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<p style="text-align:justify;">''Gulma'' is defined as large palpable, rounded, intra- abdominal swellings between ''hridaya'' (cardiac region) and the ''basti'' (bladder) regions, which develop due to excess accumulation of ''[[dosha]]s'' with predominance of ''[[vata]]''. Such swellings are either transitory or static, and display the properties of spontaneous regression and reappearance. This chapter on the treatment of ''gulma'' (abdominal lumps) first describes its general etiological factors and pathogenesis along with five places in the abdomen where the swelling occurs. The treatment of ''[[vata]] gulma'' includes ''[[snehana]]'' (oleation), ''[[swedana]]'' (sudation), ''[[brimhana]]'' (repletion), ''[[basti]]'' with ''ghee'', ''[[virechana]]'', ''[[vamana]]'' and preparations in the form of powders, pills and medicated ''ghrita'' and as a last resort bloodletting. For the treatment of ''[[pitta]] gulma'', the ''ghrita'' prepared with bitter (''tikta'') drugs, ''[[virechana]]'', recipes for ''niruha [[basti]]'', blood-letting (''[[raktamokshana]]''), use of milk, counseling (''ashvasana'') and oral recipes have been elaborated. ''Upanaha'' (poultice), ''[[shodhana]]'' and surgical measures for suppurated and internally ruptured ''gulma'' have also been described.

+

<br/>For ''[[kapha]] gulma [[snehana]]'', ''[[swedana]]'', ''bhedana'' (puncturing), ''[[langhana]]'' (lightening therapy), ''[[vamana]]'', ''[[virechana]]'', medicated ''ghee'', ''[[basti]]'', pills, powder, ''arishta'', and ''kshara'' are described. Bloodletting followed by cauterization of the ''gulma'' as a last resort is explained. A surgical procedure for ''[[rakta]] gulma'', which occurs only in women is also described.

+

<br/>Wholesome (''pathya'') food and drinks, avoidance of etiological factors, continuous protection of digestive power (''agni'') and the instructions for a patient who undergoes ''[[snehana]]'' are discussed in detail.

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</p>

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~~|header3 =~~

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'''Keywords''': ''Gulma'' (abdominal lumps), ''Pathya'' (whole some), ''[[Raktamokshana]]'' (bloodletting), ''Apathya'' (unwholesome)

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}}

== Introduction ==

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The word ''gulma'' stands for an entity that encircles, envelops or covers something. Situations such as panic, stress, or grief, usually associated with chaotic, cataclysmic event would lead to vitiation of ''vata'' causing the appearance of ''vata''-dominant diseases like ''gulma'', etc. The vitiated ''vata'', in conjunction with other ''~~doshas~~'', gets into the ''mahasrotas'' and get lodged either in the ''amashaya'' (stomach), ''pittashaya'' (gall bladder), ''pakwashaya'' (cecum) or in other regions like ''hridaya'' (epigastric), ''basti'' (bladder) and ''nabhi'' (umblicus) leading to formation of deep-rooted shrub-like mass. As mentioned earlier, ''gulma'' afflicts the gastrointestinal region between the heart and the bladder. Depending upon the region it afflicts, it can be classified into four general types common to males and females: ''vata gulma'', ''pitta gulma'', ''kapha gulma'', and ''sannipatik gulma''.

+

The word ''gulma'' stands for an entity that encircles, envelops or covers something. Situations such as panic, stress, or grief, usually associated with chaotic, cataclysmic event would lead to vitiation of ''[[vata]]'' causing the appearance of ''[[vata]]''-dominant diseases like ''gulma'', etc. The vitiated ''[[vata]]'', in conjunction with other ''[[dosha]]s'', gets into the ''mahasrotas'' and get lodged either in the ''amashaya'' (stomach), ''pittashaya'' (gall bladder), ''pakwashaya'' (cecum) or in other regions like ''hridaya'' (epigastric), ''basti'' (bladder) and ''nabhi'' (umblicus) leading to formation of deep-rooted shrub-like mass. As mentioned earlier, ''gulma'' afflicts the gastrointestinal region between the heart and the bladder. Depending upon the region it afflicts, it can be classified into four general types common to males and females: ''[[vata]] gulma'', ''[[pitta]] gulma'', ''[[kapha]] gulma'', and ''sannipatik gulma''.

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Since ''gulma'' can occur as complication of ''raktapitta'' (bleeding disorders) Charak describes this chapter after the ''raktapitta'' chapter. ''Jwara'' is the disease of ''rasavah srotas'' whereas, ''raktapitta'' is a disease of ''raktavah srotas'', in that sequence ''gulma'' is a disease of ''mansavah srotas'' and further ''prameha'' is of ''medavah srotas''. However, this chapter seems to be designed with greater implication and term ''mahasrotasa'' has been used because manifestation of disease is in the viscera/ organs up to uterus. Even then the involvement of ''vata dosha'' and ''mamsa dhatu'' is predominant in final manifestation of disease ''gulma''.

+

Since ''gulma'' can occur as complication of ''raktapitta'' (bleeding disorders) Charak describes this chapter after the ''raktapitta'' chapter. ''[[Jwara]]'' is the disease of ''rasavah srotas'' whereas, ''raktapitta'' is a disease of ''raktavah srotas'', in that sequence ''gulma'' is a disease of ''mansavah srotas'' and further ''prameha'' is of ''medavah srotas''. However, this chapter seems to be designed with greater implication and term ''mahasrotasa'' has been used because manifestation of disease is in the viscera/ organs up to uterus. Even then the involvement of ''[[vata dosha]]'' and ''[[mamsa dhatu]]'' is predominant in final manifestation of disease ''gulma''.

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It should also be noted that the same pathogenesis route and treatment procedure should be kept in mind for the disease of the ''mahasrotasa'' occurring without the true manifestation of growth/tumor. Hence peptic ulcer and ulcer dyspepsia should be treated like ''pitta gulma'' etc.

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It should also be noted that the same pathogenesis route and treatment procedure should be kept in mind for the disease of the ''mahasrotasa'' occurring without the true manifestation of growth/tumor. Hence peptic ulcer and ulcer dyspepsia should be treated like ''[[pitta]] gulma'' etc.

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''Gulma'' is defined as a palpable round compact lump in the abdomen. Thus, all the localized palpable masses in the abdomen are classified under ''gulma'', but they are named depending upon the dominance of ''dosha'' or the place. Its four types belong to ''dosha'' i.e. three of single ''dosha'' and one of a combination of all the three ''dosha'' and the fifth one is ''rakta gulma'' which occurs only in females in uterine cavity (''garbhashayashroni''). ''Sannipata Gulma'' has been given synonym as ''nichaya-gulma''.

+

''Gulma'' is defined as a palpable round compact lump in the abdomen. Thus, all the localized palpable masses in the abdomen are classified under ''gulma'', but they are named depending upon the dominance of ''[[dosha]]'' or the place. Its four types belong to ''[[dosha]]'' i.e. three of single ''[[dosha]]'' and one of a combination of all the three ''[[dosha]]'' and the fifth one is ''[[rakta]] gulma'' which occurs only in females in uterine cavity (''garbhashayashroni''). ''Sannipata Gulma'' has been given synonym as ''nichaya-gulma''.

</div>

== Sanskrit text, Transliteration and English Translation ==

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Following are the general causative factors of ''gulma'':

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*Excessive excretion of feces, ''kapha'' and ''pitta'' or due to pressure exerted by their excessive aggravation,

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*Excessive excretion of feces, ''[[kapha]]'' and ''[[pitta]]'' or due to pressure exerted by their excessive aggravation,

*Suppression of downward natural urges (like feces, flatus and urine),

*Physical trauma,

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*Excessive wrongful body activities,

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Due to the above mentioned factors ''vata'' gets aggravated in ''koshtha'' i.e. thoraco-abdominal cavity [4-5]

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Due to the above mentioned factors ''[[vata]]'' gets aggravated in ''koshtha'' i.e. thoraco-abdominal cavity [4-5]

</div>

=== General Pathogenesis of ''gulma'' ===

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</div></div>

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The provoked ''vata'' takes out ''kapha'' and ''pitta'' from their sites and in turn gets blocked its own passage by them. Thus, blocked ''vata'' is unable to move properly leading to pain in the regions of heart, umbilicus, both sides of abdomen and urinary bladder [6]

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The provoked ''[[vata]]'' takes out ''[[kapha]]'' and ''[[pitta]]'' from their sites and in turn gets blocked its own passage by them. Thus, blocked ''[[vata]]'' is unable to move properly leading to pain in the regions of heart, umbilicus, both sides of abdomen and urinary bladder [6]

=== Cardinal Signs of ''Gulma'' ===

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</div></div>

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Formation of a palpable mass in colon, gall-bladder or stomach which may be independent or associated with other dosha is known as ''gulma''. It is named according to the ''dosha'' involved. [7]

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Formation of a palpable mass in colon, gall-bladder or stomach which may be independent or associated with other dosha is known as ''gulma''. It is named according to the ''[[dosha]]'' involved. [7]

=== Five sites of ''gulma'' ===

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Five places of ''gulma'' are urinary bladder (hypogastric region), umbilical region (''nabhi''), cardiac region (''hridi'') and two flanks (''parshva''). Henceforth I will explain the causes, symptoms and the treatment of these five types of ''gulma'' [8]

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=== Causative factors of ''vata'' dominant ''gulma'' ===

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=== Causative factors of ''[[vata]]'' dominant ''gulma'' ===

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</div></div>

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Excessive use of dry articles of food and drinks, excessive or wrong body activities, suppression of natural urges, excessive grief, too-much diminution of feces, trauma and excessive fasting are the causes of ''vata-gulma'' [9]

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Excessive use of dry articles of food and drinks, excessive or wrong body activities, suppression of natural urges, excessive grief, too-much diminution of feces, trauma and excessive fasting are the causes of ''[[vata]]-gulma'' [9]

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=== Symptoms of ''vata gulma'' ===

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=== Symptoms of ''[[vata]] gulma'' ===

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</div></div>

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Frequent change in the site, shape and pain of the lump along with obstruction of feces and flatus, dryness in throat and mouth, dusky-red color of body, fever with chills, pain in the cardiac, umbilical, flanks and shoulder regions and headache are the sign and symptoms of ''vata gulma''. The symptoms decrease on taking of food but increase on completion of digestion as well as by taking dry substances or having astringent, bitter and pungent tastes [10-11]

+

Frequent change in the site, shape and pain of the lump along with obstruction of feces and flatus, dryness in throat and mouth, dusky-red color of body, fever with chills, pain in the cardiac, umbilical, flanks and shoulder regions and headache are the sign and symptoms of ''[[vata]] gulma''. The symptoms decrease on taking of food but increase on completion of digestion as well as by taking dry substances or having astringent, bitter and pungent tastes [10-11]

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=== Causative factors and pathogenesis of ''pitta'' dominant ''gulma'' ===

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=== Causative factors and pathogenesis of ''[[pitta]]'' dominant ''gulma'' ===

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</div></div>

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Taking of food articles having pungent and sour tastes and piercing, hot, irritant (''vidahi'') and dry properties; excessive wines; exposure to sun and heat; indulgence in anger, affliction by ''ama'' and vitiation of ''rakta'' are the causative factors of ''pitta-gulma'' [12]

+

Taking of food articles having pungent and sour tastes and piercing, hot, irritant (''vidahi'') and dry properties; excessive wines; exposure to sun and heat; indulgence in anger, affliction by ''ama'' and vitiation of ''[[rakta]]'' are the causative factors of ''[[pitta]]-gulma'' [12]

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=== Symptoms of ''pitta-gulma'' ===

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=== Symptoms of ''[[pitta]]-gulma'' ===

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</div></div>

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Fever, thirst, redness of mouth and other organs, excessive pain during digestion, sweating, burning sensation and tenderness in the lesion like that of ulcer are the signs and symptoms of ''pitta-gulma'' [13]

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Fever, thirst, redness of mouth and other organs, excessive pain during digestion, sweating, burning sensation and tenderness in the lesion like that of ulcer are the signs and symptoms of ''[[pitta]]-gulma'' [13]

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=== Causative factors of ''kapha-gulma'' and ''nichaya-gulma'' ===

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=== Causative factors of ''[[kapha]]-gulma'' and ''nichaya-gulma'' ===

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</div></div>

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Excessive intake of food articles having cold, heavy and unctuous properties and excessive eating, sedentary life style and day-sleep are the causative factors of ''kapha-gulma''.

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Excessive intake of food articles having cold, heavy and unctuous properties and excessive eating, sedentary life style and day-sleep are the causative factors of ''[[kapha]]-gulma''.

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All the causative factors mentioned for all the above three types of ''dosha gulma'' are also of ''nichaya'' (''tridosha'')-''gulma'' [14]

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All the causative factors mentioned for all the above three types of ''[[dosha]] gulma'' are also of ''nichaya'' (''tridosha'')-''gulma'' [14]

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=== Symptoms of ''kapha'' dominant ''gulma'' ===

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=== Symptoms of ''[[kapha]]'' dominant ''gulma'' ===

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</div></div>

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Three types of ''dvi-doshaja gulma'' (''vata-pitta, vata-kapha'' and ''kapha-pitta'') are produced by the mixture of causative factors of two involved ''dosha''. These ''gulma'' manifest the signs and symptoms of two involved ''dosha''. These varieties are mentioned here for the purpose of the treatment which can be planned on the basis of degree of provocation of each ''dosha'' [16]

+

Three types of ''dvi-doshaja gulma'' (''[[vata]]-[[pitta]], [[vata]]-[[kapha]]'' and ''[[kapha]]-[[pitta]]'') are produced by the mixture of causative factors of two involved ''[[dosha]]''. These ''gulma'' manifest the signs and symptoms of two involved ''[[dosha]]''. These varieties are mentioned here for the purpose of the treatment which can be planned on the basis of degree of provocation of each ''[[dosha]]'' [16]

=== Signs and symptoms of ''tri-doshaja gulma'' ===

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</div></div>

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The symptoms of ''tri-dosha gulma'' include agonizing pain and excessive burning sensation, elevated mass, stony hard and quick to mutilate. It is a very serious condition and leads to diminution of strength of body, mind and digestion. It is incurable [17]

+

The symptoms of ''tri-[[dosha]] gulma'' include agonizing pain and excessive burning sensation, elevated mass, stony hard and quick to mutilate. It is a very serious condition and leads to diminution of strength of body, mind and digestion. It is incurable [17]

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=== Causative factors of ''rakta gulma'' ===

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=== Causative factors of ''[[rakta]] gulma'' ===

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</div></div>

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During ''ritu-kala'' (ovulation period) if a woman does fasting or takes dry food articles or indulges in fear and suppression of natural urges; or misuses styptic (''stambhana'') drugs i.e. try to stop the menstrual bleeding; improper conduction of vomiting therapy and disorders of genital organs, all these may lead to formation of ''rakta gulma'' in women [18]

+

During ''ritu-kala'' (ovulation period) if a woman does fasting or takes dry food articles or indulges in fear and suppression of natural urges; or misuses styptic (''[[stambhana]]'') drugs i.e. try to stop the menstrual bleeding; improper conduction of vomiting therapy and disorders of genital organs, all these may lead to formation of ''[[rakta]] gulma'' in women [18]

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=== Symptoms of ''rakta gulma'' ===

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=== Symptoms of ''[[rakta]] gulma'' ===

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Now onward first the successful line of treatment shall be described for the cure of ''gulma''. Thereafter, the remedies and recipes for its cure shall be described [20]

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=== Treatment of ''vata-gulma'' ===

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=== Treatment of ''[[vata]]-gulma'' ===

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</div></div>

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As ''vata gulma'' is produced due to excessive dryness and exercise and is associated with severe pain and retention of feces and flatus, therefore in the beginning ''snehana'' (unctuous) therapy should be prescribed [21]

+

As ''[[vata]] gulma'' is produced due to excessive dryness and exercise and is associated with severe pain and retention of feces and flatus, therefore in the beginning ''[[snehana]]'' (unctuous) therapy should be prescribed [21]

−

=== ''Snehana'' for ''vata-gulma'' ===

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=== ''[[Snehana]]'' for ''[[vata]]-gulma'' ===

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</div></div>

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''Snehana'' is performed by administration of unctuous substances in the form of food and drink, oil massage and ''anuvasana basti'' along with ''niruha basti''. After proper ''snehana'', physician should subject the patient to ''swedana'' therapy [22]

+

''[[Snehana]]'' is performed by administration of unctuous substances in the form of food and drink, oil massage and ''anuvasana [[basti]]'' along with ''niruha [[basti]]''. After proper ''[[snehana]]'', physician should subject the patient to ''[[swedana]]'' therapy [22]

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=== Benefit of ''swedana'' therapy for ''vata-gulma'' ===

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=== Benefit of ''[[swedana]]'' therapy for ''[[vata]]-gulma'' ===

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</div></div>

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''Swedana'' therapy administered to a patient who has already undergone oil massage produces softness in the channels leading to alleviation of ''vata''. Thus by breaking the obstruction and opening the channels the ''vata-gulma'' is cured [23]

+

''[[Swedana]]'' therapy administered to a patient who has already undergone oil massage produces softness in the channels leading to alleviation of ''[[vata]]''. Thus by breaking the obstruction and opening the channels the ''[[vata]]-gulma'' is cured [23]

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=== Mode of Administration of ''sneha'' according to sites of ''vata gulma'' ===

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=== Mode of Administration of ''sneha'' according to sites of ''[[vata]] gulma'' ===

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</div></div>

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Oral administration of unctuous substances is beneficial in ''vata gulma'' particularly if it is situated above the umbilicus i.e. in stomach. ''Anuvasana'' (unctuous) ''basti'' is beneficial if ''gulma'' is situated in colon and both oral administration of unctuous substances and unctuous ''basti'' are beneficial if it is situated in the middle of ''jathara'' i.e. in small intestine [24]

+

Oral administration of unctuous substances is beneficial in ''[[vata]] gulma'' particularly if it is situated above the umbilicus i.e. in stomach. ''Anuvasana'' (unctuous) ''[[basti]]'' is beneficial if ''gulma'' is situated in colon and both oral administration of unctuous substances and unctuous ''[[basti]]'' are beneficial if it is situated in the middle of ''jathara'' i.e. in small intestine [24]

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</div></div>

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In ''vata gulma'' if the retention of feces and flatus is present but digestion is good then unctuous, hot and nourishing (''brimhana'') diet and drinks should be given [25]

+

In ''[[vata]] gulma'' if the retention of feces and flatus is present but digestion is good then unctuous, hot and nourishing (''[[brimhana]]'') diet and drinks should be given [25]

−

=== Repeated ''basti'' in ''vata gulma'' ===

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=== Repeated ''[[basti]]'' in ''[[vata]] gulma'' ===

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</div></div>

−

In ''vata gulma'' repeated use of unctuous drink and alternative use of ''anuvasana'' (unctuous) and ''niruha'' (un-unctuous) ''basti'' are advised in taking care of ''kapha'' and ''pitta'' [26]

+

In ''[[vata]] gulma'' repeated use of unctuous drink and alternative use of ''anuvasana'' (unctuous) and ''niruha'' (un-unctuous) ''[[basti]]'' are advised in taking care of ''[[kapha]]'' and ''[[pitta]]'' [26]

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</div></div>

−

During the treatment when ''vata'' has almost subsided but ''kapha, pitta'' or ''rakta'' gets provoked, then routine treatment of these provoked ''dosha'' should be done. In this condition, the treatment should be according to the predominance of ''dosha'' but care should be taken to protect ''vata'' in the beginning, middle and at the end of the treatment [27-28]

+

During the treatment when ''[[vata]]'' has almost subsided but ''[[kapha]], [[pitta]]'' or ''[[rakta]]'' gets provoked, then routine treatment of these provoked ''[[dosha]]'' should be done. In this condition, the treatment should be according to the predominance of ''[[dosha]]'' but care should be taken to protect ''[[vata]]'' in the beginning, middle and at the end of the treatment [27-28]

−

=== ''Vamana'' in ''vata gulma'' ===

+

=== ''[[Vamana]]'' in ''[[vata]] gulma'' ===

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</div></div>

−

In ''vata gulma'' if ''kapha'' gets increased, it causes diminution in digestion leading to anorexia, nausea, heaviness and sleepiness; such condition should be treated with ''vamana'' therapy [29]

+

In ''[[vata]] gulma'' if ''[[kapha]]'' gets increased, it causes diminution in digestion leading to anorexia, nausea, heaviness and sleepiness; such condition should be treated with ''[[vamana]]'' therapy [29]

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</div></div>

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In ''vata-kapha'' dominant ''gulma'' if there is acute pain, distension of abdomen and constipation then it should be treated with suppositories, pills and powders which are prepared from ''vata'' and ''kapha'' pacifying drugs [30]

+

In ''[[vata]]-[[kapha]]'' dominant ''gulma'' if there is acute pain, distension of abdomen and constipation then it should be treated with suppositories, pills and powders which are prepared from ''[[vata]]'' and ''[[kapha]]'' pacifying drugs [30]

−

=== ''Virechana'' in ''vata gulma'' ===

+

=== ''[[Virechana]]'' in ''[[vata]] gulma'' ===

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</div></div>

−

In ''vata gulma'' if increased ''pitta'' causes burning sensation then ''virechana'' should be done with laxative drugs mixed with unctuous substances [31]

+

In ''[[vata]] gulma'' if increased ''[[pitta]]'' causes burning sensation then ''[[virechana]]'' should be done with laxative drugs mixed with unctuous substances [31]

−

=== Blood-letting in ''vata gulma''===

+

=== Blood-letting in ''[[vata]] gulma''===

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</div></div>

−

If ''gulma'' does not subside even after proper treatment of ''vata'' etc. mentioned above then bloodletting is advised to cure it [32]

+

If ''gulma'' does not subside even after proper treatment of ''[[vata]]'' etc. mentioned above then bloodletting is advised to cure it [32]

−

=== Treatment of ''pitta'' dominant ''gulma'' ===

+

=== Treatment of ''[[pitta]]'' dominant ''gulma'' ===

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</div></div>

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If ''pitta gulma'' is caused by indulging in unctuous and hot substances then ''virechana'' is beneficial. But if it is caused by indulging in dry and hot substances then ghee is a choice of drug [33]

+

If ''[[pitta]] gulma'' is caused by indulging in unctuous and hot substances then ''[[virechana]]'' is beneficial. But if it is caused by indulging in dry and hot substances then ghee is a choice of drug [33]

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</div></div>

−

If ''pitta'' or ''pitta-gulma'' is situated in colon, the physician expert in proper and timely treatment should eliminate it by giving ''kshira-basti'' mixed with bitter drugs immediately. The physician aiming to increase the digestive power should perform ''virechana'' with milk mixed with bitter drugs or with ''tilvaka ghrita'' [34-35]

+

If ''[[pitta]]'' or ''[[pitta]]-gulma'' is situated in colon, the physician expert in proper and timely treatment should eliminate it by giving ''kshira-[[basti]]'' mixed with bitter drugs immediately. The physician aiming to increase the digestive power should perform ''[[virechana]]'' with milk mixed with bitter drugs or with ''tilvaka ghrita'' [34-35]

−

=== Blood-letting in ''pitta'' dominant ''gulma'' ===

+

=== Blood-letting in ''[[pitta]]'' dominant ''gulma'' ===

Line 684: Line 691:

</div></div>

−

The patient of ''pitta-gulma'' if having thirst, fever, burning sensation, pain, perspiration, impaired digestion and anorexia is treated with bloodletting [36]

+

The patient of ''[[pitta]]-gulma'' if having thirst, fever, burning sensation, pain, perspiration, impaired digestion and anorexia is treated with bloodletting [36]

Line 701: Line 708:

</div></div>

−

Provoked ''rakta'' is responsible for inflammation (''vidaha'') which is removed by bloodletting; thus when root-cause is removed then there will be no inflammation resulting in vanishing of swelling and pain [37]

+

Provoked ''[[rakta]]'' is responsible for inflammation (''vidaha'') which is removed by bloodletting; thus when root-cause is removed then there will be no inflammation resulting in vanishing of swelling and pain [37]

=== Diet after blood-letting ===

Line 737: Line 744:

</div></div>

−

In case of excessive increase of ''pitta'' and ''rakta'' or due to unavailability of proper treatment, if suppuration occurs then surgery should be performed by the surgeon [39]

+

In case of excessive increase of ''[[pitta]]'' and ''[[rakta]]'' or due to unavailability of proper treatment, if suppuration occurs then surgery should be performed by the surgeon [39]

=== ''Apakva gulma'' (intial non-suppurative stage) ===

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</div></div>

−

Oral administration of ghee with cleansing of the discharging ulcer with ''shodhana'' drugs are beneficial. After the cleansing, medicated ghee prepared with bitter drugs should be given with honey [48]

+

Oral administration of ghee with cleansing of the discharging ulcer with ''[[shodhana]]'' drugs are beneficial. After the cleansing, medicated ghee prepared with bitter drugs should be given with honey [48]

=== Management of ''kaphaja gulma'' ===

−

==== Indications of ''langhana'' ====

+

==== Indications of ''[[langhana]]'' ====

Line 903: Line 910:

</div></div>

−

''Kapha-gulma'' if caused by indulgence in cold, heavy and unctuous diet and in those not eligible for ''vamana, langhana'' (depletion) therapy should be prescribed in the beginning. [48]

+

''[[Kapha]]-gulma'' if caused by indulgence in cold, heavy and unctuous diet and in those not eligible for ''[[vamana]], [[langhana]]'' (depletion) therapy should be prescribed in the beginning. [48]

−

==== Indications of vamana ====

+

==== Indications of [[vamana]] ====

Line 922: Line 929:

</div></div>

−

''Vamana'' is indicated in a patient of ''gulma'' who is having low digestion, anorexia, nausea and mild pain, heaviness and stiffness in abdomen [49]

+

''[[Vamana]]'' is indicated in a patient of ''gulma'' who is having low digestion, anorexia, nausea and mild pain, heaviness and stiffness in abdomen [49]

Line 939: Line 946:

</div></div>

−

After the treatment with ''vamana'' and ''langhana'', the patient should be given hot (''ushna'') therapy and food mixed with pungent and bitter substances [50]

+

After the treatment with ''[[vamana]]'' and ''[[langhana]]'', the patient should be given hot (''ushna'') therapy and food mixed with pungent and bitter substances [50]

Line 973: Line 980:

</div></div>

−

After performing ''langhana, vamana'' and ''swedana'' therapies when digestion is improved, the patient of ''kapha gulma'' should be given ghee prepared with bitter substances and ''kshara'' (alkali preparation) at the proper time [52]

+

After performing ''[[langhana]], [[vamana]]'' and ''[[swedana]]'' therapies when digestion is improved, the patient of ''[[kapha]] gulma'' should be given ghee prepared with bitter substances and ''kshara'' (alkali preparation) at the proper time [52]

Line 990: Line 997:

</div></div>

−

By the above treatments when ''kapha gulma'' dislodges from its place, the patient should be given ''virechana'' for purification. ''Anuvasana basti'' with oil prepared with ''dashamula'' drugs can also be given for this purpose [53]

+

By the above treatments when ''[[kapha]] gulma'' dislodges from its place, the patient should be given ''[[virechana]]'' for purification. ''Anuvasana [[basti]]'' with oil prepared with ''dashamula'' drugs can also be given for this purpose [53]

Line 1,007: Line 1,014:

</div></div>

−

In the condition when digestion is low and dysfunction of ''vata'', after proper oleation of the affected site (''ashaya''), the drugs in the form of pills, powder or decoction are administered to the patient of ''kapha gulma'' [54]

+

In the condition when digestion is low and dysfunction of ''[[vata]]'', after proper oleation of the affected site (''ashaya''), the drugs in the form of pills, powder or decoction are administered to the patient of ''[[kapha]] gulma'' [54]

Line 1,024: Line 1,031:

</div></div>

−

If ''kapha-gulma'' has a deep root and is large in size, hard in consistency and heavy, then the patient should be treated with alkali preparation-''kshara, arishta'' and ''agni karma'' (cauterization) [55]

+

If ''[[kapha]]-gulma'' has a deep root and is large in size, hard in consistency and heavy, then the patient should be treated with alkali preparation-''kshara, arishta'' and ''agni karma'' (cauterization) [55]

Line 1,053: Line 1,060:

</div></div>

−

A physician expert in assessing the degree of strength of patient as well as of ''dosha'' should prescribe alkali preparation–''kshara'' to the patient of ''kapha gulma'' by considering its ''dosha'' and nature as well as prevailing season. The expert physician should use ''kshara'' treatment on alternate day or at the interval of two or three days depending on the increase or decrease in the strength of the body and ''dosha'' [56-57]

+

A physician expert in assessing the degree of strength of patient as well as of ''[[dosha]]'' should prescribe alkali preparation–''kshara'' to the patient of ''[[kapha]] gulma'' by considering its ''[[dosha]]'' and nature as well as prevailing season. The expert physician should use ''kshara'' treatment on alternate day or at the interval of two or three days depending on the increase or decrease in the strength of the body and ''[[dosha]]'' [56-57]

Line 1,070: Line 1,077:

</div></div>

−

''Kapha'' is sweet and unctuous, so it is increased by indulging in the diet comprising of excessive meat, milk and ghee. Alkali preparation-''kshara'' has an action of erosion (''ksharana'') due to which it erodes the ''gulma'' and tickles it down from its habitat [58]

+

''[[Kapha]]'' is sweet and unctuous, so it is increased by indulging in the diet comprising of excessive meat, milk and ghee. Alkali preparation-''kshara'' has an action of erosion (''ksharana'') due to which it erodes the ''gulma'' and tickles it down from its habitat [58]

Line 1,087: Line 1,094:

</div></div>

−

The diminution in digestion and loss of appetite occur in a patient of ''kapha gulma'' due to excessive indulgence in unctuous diet, therefore for the purification of the channels medicated fermented preparation-''arishta'' should be given provided the patient is habituated of taking alcohol [59]

+

The diminution in digestion and loss of appetite occur in a patient of ''[[kapha]] gulma'' due to excessive indulgence in unctuous diet, therefore for the purification of the channels medicated fermented preparation-''arishta'' should be given provided the patient is habituated of taking alcohol [59]

−

=== ''Daha karma'' and ''~~rakta mokshana~~'' in ''kapha gulma'' ===

+

=== ''Daha karma'' and ''[[raktamokshana]]'' in ''[[kapha]] gulma'' ===

Line 1,118: Line 1,125:

</div></div>

−

If the ''kapha gulma'' does not subside by ''langhana, vamana, swedana,'' oral administration of medicated ghee, ''virechana, basti'', pills, powder, ''kshara'' and ''arishta'' due to its firm root in the body, then first bloodletting should be done and then cauterization with such means as arrow head should be done [61]

+

If the ''[[kapha]] gulma'' does not subside by ''[[langhana]], [[vamana]], [[swedana]],'' oral administration of medicated ghee, ''[[virechana]], [[basti]]'', pills, powder, ''kshara'' and ''arishta'' due to its firm root in the body, then first bloodletting should be done and then cauterization with such means as arrow head should be done [61]

Line 1,135: Line 1,142:

</div></div>

−

The fire heat due to its hot and sharp properties relieves ''kapha'' and ''vata'' in ''gulma'', which in turn leads to dissolving the mass of ''gulma'' [62]

+

The fire heat due to its hot and sharp properties relieves ''[[kapha]]'' and ''[[vata]]'' in ''gulma'', which in turn leads to dissolving the mass of ''gulma'' [62]

Line 1,163: Line 1,170:

</div></div>

−

If the ''gulma'' is due to two ''dosha'' then the mix treatment of the involved two ''dosha'' should be done [64]

+

If the ''gulma'' is due to two ''[[dosha]]'' then the mix treatment of the involved two ''[[dosha]]'' should be done [64]

Line 1,193: Line 1,200:

</div></div>

−

Ghee prepared with a paste of ''trayushna'' (dry ginger, black and long pepper), ''triphala'', coriander, ''vidanga, chavya'' and ''chitraka'' by adding milk is known as ''tryushanadighritam''. It is curative of ''vata gulma''; thus described ''trayushanadighritam'' [65]

+

Ghee prepared with a paste of ''trayushna'' (dry ginger, black and long pepper), ''triphala'', coriander, ''vidanga, chavya'' and ''chitraka'' by adding milk is known as ''tryushanadighritam''. It is curative of ''[[vata]] gulma''; thus described ''trayushanadighritam'' [65]

=== ''Parama trayushanadighritam'' ===

Line 1,240: Line 1,247:

</div></div>

−

In place of milk in above preparation of ''tryushanadighritam, ghrita'' can also be prepared with ''prasanna'' wine, ''sura'' wine, pomegranate juice or cream of yogurt (curd). It also cures ''vata gulma'' [68]

+

In place of milk in above preparation of ''tryushanadighritam, ghrita'' can also be prepared with ''prasanna'' wine, ''sura'' wine, pomegranate juice or cream of yogurt (curd). It also cures ''[[vata]] gulma'' [68]

=== ''Hingusauvarchaladya ghrita'' ===

Line 1,277: Line 1,284:

</div></div>

−

A ''ghrita'' prepared with paste of asafoetida, rock salt, cumin, Vit-salt, pomegranate, ''ajwan, pushkaramula, trikatu,'' coriander, ''vetas, yavakshara, chitraka, shati, vacha, ajagandha,'' cardamom and holy basil by adding curd/yogurt is known as ''hingusauvarchaladyam ghritam''. It cures ''vata gulma'', acute pain and distension of abdomen due to retention of gases (''anaha''). Thus ''hiṅgusauvarchaladyam ghritam'' is described [69-70]

+

A ''ghrita'' prepared with paste of asafoetida, rock salt, cumin, Vit-salt, pomegranate, ''ajwan, pushkaramula, trikatu,'' coriander, ''vetas, yavakshara, chitraka, shati, vacha, ajagandha,'' cardamom and holy basil by adding curd/yogurt is known as ''hingusauvarchaladyam ghritam''. It cures ''[[vata]] gulma'', acute pain and distension of abdomen due to retention of gases (''anaha''). Thus ''hiṅgusauvarchaladyam ghritam'' is described [69-70]

=== ''Hapushadya ghritam'' ===

Line 1,326: Line 1,333:

</div></div>

−

Ghee prepared with a paste of ''hapusha, trikatu,'' cardamom, ''chavya, chitraka,'' rock salt, cumin, root of long pepper and ''ajwain'' along with juice of jujubes, radish and pomegranate, by adding milk and curd is known as ''hapushadyam ghritam''. It is best drug to cure ''vata gulma'', abdominal pain and distension of abdomen. It also provides relief in gynecological disorders, piles, ''grahani'' (assimilation disorders), dyspnea, cough, anorexia, fever and pain in hypogastric, epigastric and flanks regions of the abdomen. Thus, ''hapushadyam ghritam'' is described [71-73]

+

Ghee prepared with a paste of ''hapusha, trikatu,'' cardamom, ''chavya, chitraka,'' rock salt, cumin, root of long pepper and ''ajwain'' along with juice of jujubes, radish and pomegranate, by adding milk and curd is known as ''hapushadyam ghritam''. It is best drug to cure ''[[vata gulma]]'', abdominal pain and distension of abdomen. It also provides relief in gynecological disorders, piles, ''grahani'' (assimilation disorders), dyspnea, cough, anorexia, fever and pain in hypogastric, epigastric and flanks regions of the abdomen. Thus, ''hapushadyam ghritam'' is described [71-73]

=== ''Pippalyadyam ghritam'' ===

Line 1,363: Line 1,370:

</div></div>

−

Ghee prepared with paste of one and half part of long pepper, eight parts of pomegranate seeds, four parts of coriander and one part of dry ginger in 20 parts of ghee and 80 parts of milk is known as ''pippalyadyam ghritam''. It provides quick relief in ''vata gulma'', pain in vagina, headache, piles and irregular fever. Thus ''pippalyadyam ghritam'' is described [74-75]

+

Ghee prepared with paste of one and half part of long pepper, eight parts of pomegranate seeds, four parts of coriander and one part of dry ginger in 20 parts of ghee and 80 parts of milk is known as ''pippalyadyam ghritam''. It provides quick relief in ''[[vata]] gulma'', pain in vagina, headache, piles and irregular fever. Thus ''pippalyadyam ghritam'' is described [74-75]

Line 1,505: Line 1,512:

This powder is to be given with food and drinks or it may be taken before meal as drink mixed with wine or hot water. This has no harmful effect.

−

It is useful in ''vata-kapha gulma,'' pain in hypogastric, epigastric and hypochondric regions of the abdomen, distension of abdomen, dysuria, pain in anus and vagina, assimilation disorders, piles, spleen disorders, anemia, anorexia, tightness of chest, hiccup, cough, dyspnoea and sore-throat.

+

It is useful in ''[[vata]]-[[kapha]] gulma,'' pain in hypogastric, epigastric and hypochondric regions of the abdomen, distension of abdomen, dysuria, pain in anus and vagina, assimilation disorders, piles, spleen disorders, anemia, anorexia, tightness of chest, hiccup, cough, dyspnoea and sore-throat.

The pills may also be prepared by repeatedly impregnating the above mentioned powders in juice of citron, which is more effective than administration of the simple powders. Thus ''hingvadichurnam'' and ''gutika'' have been described [79-84]

Line 1,524: Line 1,531:

</div></div>

−

Mix asafoetida, pomegranate and bid and rock salts in juice of citron and take with supernatant fluid of ''surā'' wine. It cures pain of ''vata gulma'' [85]

+

Mix asafoetida, pomegranate and bid and rock salts in juice of citron and take with supernatant fluid of ''surā'' wine. It cures pain of ''[[vata]] gulma'' [85]

=== ''Shatyadi churnam'' and ''gutika'' ===

Line 1,617: Line 1,624:

</div></div>

−

Make paste of 25 gm of dried ginger, 100 gm pealed sesame and 50 gm of jaggery and administer to the patient with warm milk. It cures ''vata gulma, udavarta'' ( disorder due to improper direction of ''vata'') and pain in vagina [91½]

+

Make paste of 25 gm of dried ginger, 100 gm pealed sesame and 50 gm of jaggery and administer to the patient with warm milk. It cures ''[[vata]] gulma, udavarta'' ( disorder due to improper direction of ''[[vata]]'') and pain in vagina [91½]

Line 1,640: Line 1,647:

</div></div>

−

The patient of ''vata gulma'' associated with ''kapha'' dominance, then should take castor oil with supernatant of ''varuni'' wine and if ''pitta'' is associated then take castor oil with milk [92-93]

+

The patient of ''[[vata]] gulma'' associated with ''[[kapha]]'' dominance, then should take castor oil with supernatant of ''varuni'' wine and if ''[[pitta]]'' is associated then take castor oil with milk [92-93]

=== ''Lashuna-kshiram'' ===

Line 1,677: Line 1,684:

</div></div>

−

Take 160 gm of dried and peeled garlic, add to it 640 ml of milk and 640 ml of water and boil on slow fire till only milk remains. It is known as ''lashuna kshiram'' and its oral administration provides quick relief in ''vata gulma, udavarta,'' sciatica, irregular fever, heart disease, abscess and inflammation [94-95]

+

Take 160 gm of dried and peeled garlic, add to it 640 ml of milk and 640 ml of water and boil on slow fire till only milk remains. It is known as ''lashuna kshiram'' and its oral administration provides quick relief in ''[[vata]] gulma, udavarta,'' sciatica, irregular fever, heart disease, abscess and inflammation [94-95]

=== ''Taila panchakam'' ===

Line 1,727: Line 1,734:

</div></div>

−

Taking of ''shilajatu'' with ''kshara'' and decoction of ''panchamula'' cures ''vata gulma''. Thus administration of ''shilajatu'' is described [97]

+

Taking of ''shilajatu'' with ''kshara'' and decoction of ''panchamula'' cures ''[[vata]] gulma''. Thus administration of ''shilajatu'' is described [97]

=== ''Vatyam'' or barley preparation ===

Line 1,746: Line 1,753:

</div></div>

−

Taking of barley meal mixed with unctuous substances along with soup of long pepper or juice of radish, provides relief in ''vata gulma'' and ''udavarta'' [98]

+

Taking of barley meal mixed with unctuous substances along with soup of long pepper or juice of radish, provides relief in ''[[vata]] gulma'' and ''udavarta'' [98]

−

=== ''Swedana'' ===

+

=== ''[[Swedana]]'' ===

Line 1,765: Line 1,772:

</div></div>

−

If the patient of ''vata gulma'' is also having the complaints of distension of abdomen and constipation then ''swedana'' therapy should be given in the form of ''nadi'' (cattle sudation), ''prastara'' (stone slab sudation) and ''sankara'' (mix sudation) ''sweda'' as described in [[Swedadhyaya]] [99]

+

If the patient of ''[[vata]] gulma'' is also having the complaints of distension of abdomen and constipation then ''[[swedana]]'' therapy should be given in the form of ''nadi'' (cattle sudation), ''prastara'' (stone slab sudation) and ''sankara'' (mix sudation) ''sweda'' as described in [[Swedadhyaya]] [99]

−

=== ''Basti karma'' ===

+

=== ''[[Basti]] karma'' ===

Line 1,802: Line 1,809:

</div></div>

−

''Basti Karma'' is the best treatment of ''gulma'' because it first conquers ''vata'' at its natural site and then cures ''gulma'' quickly. Therefore ''niruha'' and ''anuvasana basti'' should be administered repeatedly for cure of ''vata, pitta'' and ''kapha gulma''. Various types of ''basti'' for the cure of ''gulma'' shall be described in [[Basti Siddhi]] [100-101]

+

''[[Basti]] Karma'' is the best treatment of ''gulma'' because it first conquers ''[[vata]]'' at its natural site and then cures ''gulma'' quickly. Therefore ''niruha'' and ''anuvasana [[basti]]'' should be administered repeatedly for cure of ''[[vata]], [[pitta]]'' and ''[[kapha]] gulma''. Various types of ''[[basti]]'' for the cure of ''gulma'' shall be described in [[Basti Siddhi]] [100-101]

=== Medicated oils ===

Line 1,827: Line 1,834:

</div></div>

−

The various types of medicated oil useful for ''gulma'' will be described in [[Vatavyadhi Chikitsa]]. The medicated oils are used for oral administration, massage and ''anuvasana basti''. As oil is best therapy for ''vata'' therefore it cures ''vata gulma'' quickly [102-103]

+

The various types of medicated oil useful for ''gulma'' will be described in [[Vatavyadhi Chikitsa]]. The medicated oils are used for oral administration, massage and ''anuvasana [[basti]]''. As oil is best therapy for ''[[vata]]'' therefore it cures ''[[vata]] gulma'' quickly [102-103]

Line 1,844: Line 1,851:

</div></div>

−

Accumulated feces of the patient of ''vata gulma'' should be eliminated by giving earlier mentioned ''ghrita'' mixed with powder ''nilini''.[104]

+

Accumulated feces of the patient of ''[[vata]] gulma'' should be eliminated by giving earlier mentioned ''ghrita'' mixed with powder ''nilini''.[104]

=== ''Nilinyadyam ghritam'' ===

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</div></div>

−

The ghee prepared with ''nilini, trivrita, danti, haritaki'' and ''kampillaka'' along with bid-salt and ''kshara'' should be given for ''shodhana'' [105]

+

The ghee prepared with ''nilini, trivrita, danti, haritaki'' and ''kampillaka'' along with bid-salt and ''kshara'' should be given for ''[[shodhana]]'' [105]

=== ''Nilinyadyam ghritam'' ===

Line 1,924: Line 1,931:

</div></div>

−

Take 50 gm each of ''nilini, triphala, rasna, bala, katuki, vidanga'' and ''kantakari'' and add to it 2.5 litres of water and prepare the decoction by reducing it to one-fourth. Add to it 640 ml of ghee, 640 ml of curd and 50 ml of latex of ''snuhi'' and prepare ghee as per method of ''sneha-paka''. Its 40 ml mixed with ''manda'' (liquid obtained by filtering the boiled rice) should be given for ''virechana''. When the patient is well purged and the drug is digested then meat soup is given in diet.

+

Take 50 gm each of ''nilini, triphala, rasna, bala, katuki, vidanga'' and ''kantakari'' and add to it 2.5 litres of water and prepare the decoction by reducing it to one-fourth. Add to it 640 ml of ghee, 640 ml of curd and 50 ml of latex of ''snuhi'' and prepare ghee as per method of ''sneha-paka''. Its 40 ml mixed with ''manda'' (liquid obtained by filtering the boiled rice) should be given for ''[[virechana]]''. When the patient is well purged and the drug is digested then meat soup is given in diet.

This ''ghrita'' cures ''gulma, kushtha, udara roga, vyanga'' (freckles), swellings, anemia, fever, leukoderma, splenomegaly and psychic disorders (''unmada''). Thus ''nilinyadi ghritam'' is described [106-109]

−

=== ''Pathya'' in ''vata gulma'' ===

+

=== ''Pathya'' in ''[[vata]] gulma'' ===

Line 1,957: Line 1,964:

</div></div>

−

Hot, liquid and unctuous diet is beneficial for the patient of ''vata gulma''. Red rice, wine and ghee; meats of chicken, peacock, partridge (''tittara''), ''krauncha'' (demoiselle) and quail (''vartaka'') are beneficial for the patient of ''vata gulma''.

+

Hot, liquid and unctuous diet is beneficial for the patient of ''[[vata]] gulma''. Red rice, wine and ghee; meats of chicken, peacock, partridge (''tittara''), ''krauncha'' (demoiselle) and quail (''vartaka'') are beneficial for the patient of ''[[vata]] gulma''.

Similarly a potion of ''varuni'' wine with ''manda'' (supernatant fluid of boiled rice) or water boiled with coriander is beneficial [110-111]

Line 1,997: Line 2,004:

</div></div>

−

In all types of ''gulma'', only that successive treatment is fruitful which is given after subjecting first the patient to ''snehana'' and then ''swedana'', but it never success if given after un-unctuous (''ruksha'') treatment [113]

+

In all types of ''gulma'', only that successive treatment is fruitful which is given after subjecting first the patient to ''[[snehana]]'' and then ''[[swedana]]'', but it never success if given after un-unctuous (''ruksha'') treatment [113]

−

=== Management of ''pitta gulma'' ===

+

=== Management of ''[[pitta]] gulma'' ===

Line 2,016: Line 2,023:

</div></div>

−

Physician while dealing with pitta ''gulma'' should know that it requires immediate treatment (''atyayika''). ''Pitta gulma'' patient should be given ghee prepared with purgative and bitter drugs [114]

+

Physician while dealing with pitta ''gulma'' should know that it requires immediate treatment (''atyayika''). ''[[Pitta]] gulma'' patient should be given ghee prepared with purgative and bitter drugs [114]

=== ''Rohiṇyadya ghritam'' ===

Line 2,065: Line 2,072:

</div></div>

−

Take 10 gm each of ''katuka, neem,'' liquorices, ''triphala'' and ''trayamana''; 40 gm each of ''patola'' and ''trivrita''; 80 gm of lentil (''masura'') and add to it 8 times water; boil on low fire till it reduces to 160 ml. Add to it equal quantity of ghee i.e. 160 ml and administer it to the patient orally. It alleviates ''pitta gulma,'' fever, thirst, abdominal pain, giddiness, fainting and anorexia. Thus ''rohinyadi ghrita'' is described [117]

+

Take 10 gm each of ''katuka, neem,'' liquorices, ''triphala'' and ''trayamana''; 40 gm each of ''patola'' and ''trivrita''; 80 gm of lentil (''masura'') and add to it 8 times water; boil on low fire till it reduces to 160 ml. Add to it equal quantity of ghee i.e. 160 ml and administer it to the patient orally. It alleviates ''[[pitta]] gulma,'' fever, thirst, abdominal pain, giddiness, fainting and anorexia. Thus ''rohinyadi ghrita'' is described [117]

=== ''Trayamaṇadi ghritam'' ===

Line 2,126: Line 2,133:

</div></div>

−

Make decoction by adding 10 times of water to 160 gm of ''trayamana'' and reducing it to one fifth. To this decoction add 10 gm paste of ''katuka, mustaka, trayamana'' and ''duralabha''; 10 gm paste of ''tamalaki, veera, jivanti, chandana'' and lotus; add to it 320 ml juice of ''amalaki,'' milk and ghee. From all these, prepare ghrita as per method of ''sneha pāka''. It is best ''ghrita'' to cure ''pitta'' and ''rakta-gulma, visarpa, pitta jwara,'' heart disease, jaundice and ''kushtha''. Thus ''trayamanadi ghritam'' is described [118-121]

+

Make decoction by adding 10 times of water to 160 gm of ''trayamana'' and reducing it to one fifth. To this decoction add 10 gm paste of ''katuka, mustaka, trayamana'' and ''duralabha''; 10 gm paste of ''tamalaki, veera, jivanti, chandana'' and lotus; add to it 320 ml juice of ''amalaki,'' milk and ghee. From all these, prepare ghrita as per method of ''sneha pāka''. It is best ''ghrita'' to cure ''pitta'' and ''[[rakta]]-gulma, visarpa, [[pitta]] jwara,'' heart disease, jaundice and ''kushtha''. Thus ''trayamanadi ghritam'' is described [118-121]

=== ''Amalakadi ghritam'' ===

Line 2,200: Line 2,207:

</div></div>

−

Take 40 gm each of raisin, ''madhuka'' (mahva), date, ''vidari, shatavari, parushaka'' and ''triphala'' and add to it 2560 ml of water and boil till reduced to one-fourth. To this decoction add 640 gm each of ghee, sugar-cane juice, juice of ''amalaki'' and milk and its one fourth part of paste of ''haritaki''; and prepare ''ghrita'' as per method of ''sneha-paka''. Take this ghee by adding one fourth quantities of sugar and honey. It cures ''pitta-gulma'' and all types of pitta disorders. Thus ''drakshdyam ghritam'' is described [123-125]

+

Take 40 gm each of raisin, ''madhuka'' (mahva), date, ''vidari, shatavari, parushaka'' and ''triphala'' and add to it 2560 ml of water and boil till reduced to one-fourth. To this decoction add 640 gm each of ghee, sugar-cane juice, juice of ''amalaki'' and milk and its one fourth part of paste of ''haritaki''; and prepare ''ghrita'' as per method of ''sneha-paka''. Take this ghee by adding one fourth quantities of sugar and honey. It cures ''[[pitta]]-gulma'' and all types of pitta disorders. Thus ''drakshdyam ghritam'' is described [123-125]

=== ''Vasaghr̥itam'' ===

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</div></div>

−

Take whole plant of ''vasa'' including its root and make decoction by adding to it eight times water and reducing to one-eighth. Add to the decoction, paste of its flower and ghee and prepare the ''ghrita''. It is to be taken with honey which cures ''pitta gulma'', piles, fever, dyspnea, cough and heart disease. Thus ''vasaghritam'' is described [126-127]

+

Take whole plant of ''vasa'' including its root and make decoction by adding to it eight times water and reducing to one-eighth. Add to the decoction, paste of its flower and ghee and prepare the ''ghrita''. It is to be taken with honey which cures ''[[pitta]] gulma'', piles, fever, dyspnea, cough and heart disease. Thus ''vasaghritam'' is described [126-127]

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</div></div>

−

Take 80 gm of ''trayamana'' and make decoction by adding 1.280 litre of water and reducing to one-eighth and filter it. Take it by adding equal quantity of warm milk and thereafter take as much milk as one can digest. This preparation eliminates the toxic substances and thus cures ''pitta gulma'' [128-129]

+

Take 80 gm of ''trayamana'' and make decoction by adding 1.280 litre of water and reducing to one-eighth and filter it. Take it by adding equal quantity of warm milk and thereafter take as much milk as one can digest. This preparation eliminates the toxic substances and thus cures ''[[pitta]] gulma'' [128-129]

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</div></div>

−

In patient of ''pitta gulma'' the ''virechana'' can be performed by administration of decoction of raisins and ''haritaki'' with jaggery or by licking powder of ''kampillaka'' with honey [130]

+

In patient of ''[[pitta]] gulma'' the ''[[virechana]]'' can be performed by administration of decoction of raisins and ''haritaki'' with jaggery or by licking powder of ''kampillaka'' with honey [130]

=== Massage ===

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For relieving burning sensation in the patient of ''gulma'', massage with ghee or ''chandanadi taila'' or medicated oil prepared with ''madhuka'' should be done [131]

−

=== ''Kshira-basti'' for ''pitta gulma'' ===

+

=== ''Kshira-[[basti]]'' for ''[[pitta]] gulma'' ===

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</div></div>

−

''Kshira-basti'' comprising of bitter drugs described for ''pitta'' fever as well as which will be described in [[Siddhi Sthana]] are also beneficial for curing ''pitta gulma'' [132]

+

''Kshira-[[basti]]'' comprising of bitter drugs described for ''[[pitta]]'' fever as well as which will be described in [[Siddhi Sthana]] are also beneficial for curing ''[[pitta]] gulma'' [132]

−

=== ''Pathya'' for ''pitta gulma'' ===

+

=== ''Pathya'' for ''[[pitta]] gulma'' ===

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</div></div>

−

Red rice, meat of wild animals, milk and ghee of cow and goat, dates, grapes, pomegranates, ''amalaki'' and ''parushaka'' are wholesome diet articles for eating and water boiled with ''bala-vidarigandhadi'' drugs for drinking for the patient of ''pitta gulma'' [133-134]

+

Red rice, meat of wild animals, milk and ghee of cow and goat, dates, grapes, pomegranates, ''amalaki'' and ''parushaka'' are wholesome diet articles for eating and water boiled with ''bala-vidarigandhadi'' drugs for drinking for the patient of ''[[pitta]] gulma'' [133-134]

=== Management of ''ama'' associated ''gulma'' ===

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</div></div>

−

''Pitta gulma'' or ''kapha-vata gulma'' if associated with ''ama'', first it should be subjected to ''langhana'' and then given cooked rice (''yavagu'') and vegetable or pulse soup to enhance the digestion [135]

+

''[[Pitta]] gulma'' or ''[[kapha]]-[[vata]] gulma'' if associated with ''ama'', first it should be subjected to ''[[langhana]]'' and then given cooked rice (''yavagu'') and vegetable or pulse soup to enhance the digestion [135]

=== Importance of ''agni'' ===

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</div></div>

−

Equilibrium or provocation of all the ''dosha'' depend upon the condition of ''agni'' (digestion and metabolism), hence one should always take its care and avoid such causes which disturb it [136]

+

Equilibrium or provocation of all the ''[[dosha]]'' depend upon the condition of ''agni'' (digestion and metabolism), hence one should always take its care and avoid such causes which disturb it [136]

=== Treatment of ''kaphaja gulma'' ===

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</div></div>

−

''Vamana karma'' should be done in ''kapha gulma'' provided the patient is fit for it [136½]

+

''[[Vamana]] karma'' should be done in ''[[kapha]] gulma'' provided the patient is fit for it [136½]

−

==== Surgical treatment of ''kapha gulma'' ====

+

==== Surgical treatment of ''[[kapha]] gulma'' ====

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</div></div>

−

First make the ''kapha gulma'' loose (''shaithilya'') by ''snehana'' and ''swedana'' therapies then following operation should be performed on the patient:

+

First make the ''[[kapha]] gulma'' loose (''shaithilya'') by ''[[snehana]]'' and ''[[swedana]]'' therapies then following operation should be performed on the patient:

Cover the brim of ''gulma'' with a piece of cloth and on the inner portion of the brim put an earthen lid containing ignited ''balvaja'' or small sacrificial grass (''kusha''). Then place the mouth of an inverted empty pot on it in such a way so that it covers and fit on the brim. Due to negative pressure produced inside the pot by the fire, the mouth of the pot will strongly adhere to the brim and the lump will be pulled into the pot. Then remove the pot and tightly tie the bottom of this bulged portion of the ''gulma'' and then puncture it. Thereafter, with the help of any available instruments such as ''vimarga, ajapada'' and ''adarsha'', only the ''gulma'' part is squeezed or compressed, without touching the intestines and heart. This operation should be done only by the expert surgeon in the technique [137-140]

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</div></div>

−

Prepare a medicated ghee with decoction of ''dashamula,'' paste of ''trikatu, yavakshara,'' salt, asafoetida, bid-salt and pomegranate, and ghee. Its oral use quickly subsides ''kapha gulma''. Thus ''dashamuli-ghritam'' is described. [142]

+

Prepare a medicated ghee with decoction of ''dashamula,'' paste of ''trikatu, yavakshara,'' salt, asafoetida, bid-salt and pomegranate, and ghee. Its oral use quickly subsides ''[[kapha]] gulma''. Thus ''dashamuli-ghritam'' is described. [142]

=== ''Bhallatakadi ghritam'' ===

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</div></div>

−

Take coarse powder of 80 gm of ''bhallataka,'' 40 gm of ''laghu panchamula'' and 40 gm of ''vidarigandhadi'' and prepare a decoction by adding 2.5 liters of water and reducing to one-fourth. To this decoction add paste made of 10 gm each of long pepper, dry ginger, ''vacha, vidanga,'' rock and bid salts, asafoetida, ''yavakshara, chitraka, shati,'' liquorices and ''rasna''; 640 ml each of milk and ghee and make ''ghrita'' as per method of ''sneha paka''. Oral use of ''bhallatakadyam ghritam'' is best for providing cure to ''kapha gulma''. It also provides relief in spleen disorders, anemia, asthma, assimilation disorders and cough. Thus ''bhallatakadyam ghritam'' is described [143-146]

+

Take coarse powder of 80 gm of ''bhallataka,'' 40 gm of ''laghu panchamula'' and 40 gm of ''vidarigandhadi'' and prepare a decoction by adding 2.5 liters of water and reducing to one-fourth. To this decoction add paste made of 10 gm each of long pepper, dry ginger, ''vacha, vidanga,'' rock and bid salts, asafoetida, ''yavakshara, chitraka, shati,'' liquorices and ''rasna''; 640 ml each of milk and ghee and make ''ghrita'' as per method of ''sneha paka''. Oral use of ''bhallatakadyam ghritam'' is best for providing cure to ''[[kapha]] gulma''. It also provides relief in spleen disorders, anemia, asthma, assimilation disorders and cough. Thus ''bhallatakadyam ghritam'' is described [143-146]

=== ''Kshiraṣhaṭpalaka ghritam'' ===

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</div></div>

−

Make a paste of 40 gm each of fruits and roots of long pepper, ''chavya'' and ''chitraka, yavakshara'' and dried ginger and add to it 640 gm each of ghee and milk, and prepare a medicated ghee. This ''ghrita'' cures ''kapha gulma, grahani'' (chronic assimilation disorders), anemia, spleen disorders, cough and fever. Thus ''kshirashatpalakam ghritam'' is described [147-148]

+

Make a paste of 40 gm each of fruits and roots of long pepper, ''chavya'' and ''chitraka, yavakshara'' and dried ginger and add to it 640 gm each of ghee and milk, and prepare a medicated ghee. This ''ghrita'' cures ''[[kapha]] gulma, grahani'' (chronic assimilation disorders), anemia, spleen disorders, cough and fever. Thus ''kshirashatpalakam ghritam'' is described [147-148]

=== ''Mishraka sneha'' ===

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</div></div>

−

Prepare a decoction of 40 gm each of ''trivrita, triphala, danti'' and ''dashamula'' by adding four times of water and reducing to one-fourth. In this decoction add ghee, castor oil and milk and prepare medicated ghee. This ''mishraka sneha'' taken orally by adding honey cures ''kapha gulma''. It also provides relief in constipation due to ''kapha'' and ''vata, kushtha'' (chronic skin disorders), spleen disorders and ''udara-roga'' (generalized enlargement of abdomen) and especially useful in vaginal pain. Thus ''mishraka sneha'' is described [149-151]

+

Prepare a decoction of 40 gm each of ''trivrita, triphala, danti'' and ''dashamula'' by adding four times of water and reducing to one-fourth. In this decoction add ghee, castor oil and milk and prepare medicated ghee. This ''mishraka sneha'' taken orally by adding honey cures ''[[kapha]] gulma''. It also provides relief in constipation due to ''[[kapha]]'' and ''[[vata]], kushtha'' (chronic skin disorders), spleen disorders and ''udara-roga'' (generalized enlargement of abdomen) and especially useful in vaginal pain. Thus ''mishraka sneha'' is described [149-151]

−

=== ''Virechana'' in ''kapha gulma'' ===

+

=== ''[[Virechana]]'' in ''[[kapha]] gulma'' ===

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</div></div>

−

''Nilini-ghrita'' already described as laxative for the cure of ''vata gulma'' should be used in double the dose for ''virechana'' in the patient of ''kapha gulma''.

+

''Nilini-ghrita'' already described as laxative for the cure of ''[[vata]] gulma'' should be used in double the dose for ''[[virechana]]'' in the patient of ''[[kapha]] gulma''.

−

10 gm powder of ''trivrita'' well impregnated with latex of ''snuhi'' taken with ghee and honey may also be used to produce a good ''virechana'' [152-153]

+

10 gm powder of ''trivrita'' well impregnated with latex of ''snuhi'' taken with ghee and honey may also be used to produce a good ''[[virechana]]'' [152-153]

=== ''Danti-haritaki'' ===

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</div></div>

−

Prepare a decoction of 25 ''haritaki'' and 50 gm each of ''danti'' and ''chitraka'' in 10 liters of water by reducing it to one-eighth. Add jaggery equal to quantity of ''danti'' to the decoction and filter again and add to it ''haritaki'', 80 ml of sesame oil, 160 gm of ''trivrita'' powder and 40 gm each of long pepper and dry ginger and by heating made into constituency of the jam. On cooling add 80 gm of honey, 40 gm powder of cinnamon, cardamom, ''tamalapatra'' and ''keshara''. Administer its 40 gm with one ''haritaki'' daily to a person who has already been prepared with ''snehana'' and ''swedana'' for a good ''virechana''. It will remove 640 gm of morbid material (''dosha prastha'') without producing any side effect.

+

Prepare a decoction of 25 ''haritaki'' and 50 gm each of ''danti'' and ''chitraka'' in 10 liters of water by reducing it to one-eighth. Add jaggery equal to quantity of ''danti'' to the decoction and filter again and add to it ''haritaki'', 80 ml of sesame oil, 160 gm of ''trivrita'' powder and 40 gm each of long pepper and dry ginger and by heating made into constituency of the jam. On cooling add 80 gm of honey, 40 gm powder of cinnamon, cardamom, ''tamalapatra'' and ''keshara''. Administer its 40 gm with one ''haritaki'' daily to a person who has already been prepared with ''[[snehana]]'' and ''[[swedana]]'' for a good ''[[virechana]]''. It will remove 640 gm of morbid material (''[[dosha]] prastha'') without producing any side effect.

−

This decoction for ''virechana'' will cure ''gulma'', swellings, piles, anemia, anorexia, heart disease, chronic assimilation disorders, jaundice, irregular fever, ''kushtha'', spleen disorders and distension of abdomen. The therapy does not produce any complication. During this therapy liquid diet and rice with meat soup are given to eat. Thus ''dantiharitaki'' is described [154-160]

+

This decoction for ''[[virechana]]'' will cure ''gulma'', swellings, piles, anemia, anorexia, heart disease, chronic assimilation disorders, jaundice, irregular fever, ''kushtha'', spleen disorders and distension of abdomen. The therapy does not produce any complication. During this therapy liquid diet and rice with meat soup are given to eat. Thus ''dantiharitaki'' is described [154-160]

−

=== ''Basti'' in ''kapha gulma'' ===

+

=== ''[[Basti]]'' in ''[[kapha]] gulma'' ===

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</div></div>

−

The most effective ''niruha basti'' for ''kapha gulma'' will be described in [[Siddhi Sthana]] and most effective medicated wines (''arishta'') will be described in the chapter on [[Grahani Chikitsa]] and [[Arsha Chikitsa]] [161]

+

The most effective ''niruha [[basti]]'' for ''[[kapha]] gulma'' will be described in [[Siddhi Sthana]] and most effective medicated wines (''arishta'') will be described in the chapter on [[Grahani Chikitsa]] and [[Arsha Chikitsa]] [161]

=== Powders and pills ===

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</div></div>

−

Powder and pills which are described for the treatment of ''vata gulma'' should also be used for ''kapha gulma'' but added with double the quantity of mixture of ''kshara,'' asafoetida and ''amlavetasa'' [162]

+

Powder and pills which are described for the treatment of ''[[vata]] gulma'' should also be used for ''[[kapha]] gulma'' but added with double the quantity of mixture of ''kshara,'' asafoetida and ''amlavetasa'' [162]

=== ''Kshara'' and ''daha karma'' ===

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</div></div>

−

''Kshara'' preparations mentioned in [[Grahani Chikitsa]] are also beneficial for ''kapha gulma'' without any side effect. If above mentioned treatment does not cure ''kapha gulma'' then cauterization should be done as a last resort [163]

+

''Kshara'' preparations mentioned in [[Grahani Chikitsa]] are also beneficial for ''[[kapha]] gulma'' without any side effect. If above mentioned treatment does not cure ''[[kapha]] gulma'' then cauterization should be done as a last resort [163]

−

=== ''Pathya'' for ''kapha gulma'' ===

+

=== ''Pathya'' for ''[[kapha]] gulma'' ===

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</div></div>

−

More than one year old grains, meat of wild animals and birds, soup of horse-gram (''kulattha'') or green gram (''mudga''), long pepper, dry ginger, dry radish, ''bilva, varuna,'' sprouts of ''chirabilva, yavani'' and ''chitraka'' are beneficial diet articles for the patient of ''kapha gulma'' [165]

+

More than one year old grains, meat of wild animals and birds, soup of horse-gram (''kulattha'') or green gram (''mudga''), long pepper, dry ginger, dry radish, ''bilva, varuna,'' sprouts of ''chirabilva, yavani'' and ''chitraka'' are beneficial diet articles for the patient of ''[[kapha]] gulma'' [165]

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</div></div>

−

Citron, asafoetida, ''amlavetas, kshara,'' pomegranate, butter milk, oil and ghee preparations are also wholesome for ''kapha gulma'' [166]

+

Citron, asafoetida, ''amlavetas, kshara,'' pomegranate, butter milk, oil and ghee preparations are also wholesome for ''[[kapha]] gulma'' [166]

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</div></div>

−

Water boiled in ''laghu panchamula'' or old ''varuni'' or old honey wine should be given to drink on getting the thirst to the patient of ''kapha gulma'' [167]

+

Water boiled in ''laghu panchamula'' or old ''varuni'' or old honey wine should be given to drink on getting the thirst to the patient of ''[[kapha]] gulma'' [167]

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</div></div>

−

Taking of butter milk mixed with ''yavani'' (''ajwain'') and salted with bid-salt acts as a digestive stimulant and the regulator of flatus, urine and ''kapha'' [168]

+

Taking of butter milk mixed with ''yavani'' (''ajwain'') and salted with bid-salt acts as a digestive stimulant and the regulator of flatus, urine and ''[[kapha]]'' [168]

=== Signs and symptoms of incurable ''gulma'' ===

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The patient of ''gulma'' accompanied with fever, dyspnea, vomiting and diarrhea along with edema in the epigastric and umbilical regions and on hands and feet indicate that the patient is approaching to death [171]

−

=== Treatment of ''rakta gulma'' ===

+

=== Treatment of ''[[rakta]] gulma'' ===

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</div></div>

−

The treatment of ''rakta gulma'' should be under taken only after completion of normal period of gestation i.e. 10 months. The patient should be given unctuous ''virechana'' after preparing with ''snehana'' and ''swedana'' [172]

+

The treatment of ''[[rakta]] gulma'' should be under taken only after completion of normal period of gestation i.e. 10 months. The patient should be given unctuous ''[[virechana]]'' after preparing with ''[[snehana]]'' and ''[[swedana]]'' [172]

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</div></div>

−

If the above mentioned treatments do not break the ''rakta gulma'' then the preparations which cleans vagina should be used locally.

+

If the above mentioned treatments do not break the ''[[rakta]] gulma'' then the preparations which cleans vagina should be used locally.

A swab well saturated with one of the following pastes may be inserted in the vagina:

−

*Sesame paste mixed with ''~~kshaara~~'' or latex of ''snuhi'' or

+

*Sesame paste mixed with ''kshara'' or latex of ''snuhi'' or

*Pungent fish impregnated with both ''kshara'' and latex of ''snuhi''

*Bile of hog or fish or emetic or purgative drugs or with honey

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</div></div>

−

''Basti'' prepared with milk, cow’s urine, ''kshara'' and decoction of ''dashamula'' should be given. Even after all these treatments, if blood does not flow from vagina then surgical intervention is required [178]

+

''[[Basti]]'' prepared with milk, cow’s urine, ''kshara'' and decoction of ''dashamula'' should be given. Even after all these treatments, if blood does not flow from vagina then surgical intervention is required [178]

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</div></div>

−

In case of excessive bleeding, the measures curative of ''raktapitta'' should be prescribed. If the patient gets ''vata'' type of pains then all the remedies curative of ''vata'' are given [180]

+

In case of excessive bleeding, the measures curative of ''raktapitta'' should be prescribed. If the patient gets ''[[vata]]'' type of pains then all the remedies curative of ''[[vata]]'' are given [180]

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Effusion with ghee and oil should be performed. Meat of partridge (''tittara'') and rooster (''charanayudha''), ''sura'' (wine) along with its upper fluid (''manda'') and ghee prepared with sour drugs may be given in diet.

−

''Uttara basti'' with ghee prepared with ''jivaniya'' drugs should be given. In case of the excessive blood flow, ''anuvasana basti'' with ghee/oil prepared with bitter drugs should be given [181-182]

+

''Uttara basti'' with ghee prepared with ''jivaniya'' drugs should be given. In case of the excessive blood flow, ''anuvasana [[basti]]'' with ghee/oil prepared with bitter drugs should be given [181-182]

=== Summary ===

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</div></div>

−

In this chapter, ''sneha, sweda, sarpi-basti, churna, brimhana, gudika, vamana, virechana'' and ''~~rakta mokshana~~'' for the patient suffering from ''vata-gulma'' have been described.

+

In this chapter, ''sneha, sweda, sarpi-[[basti]], churna, [[brimhana]], gudika, [[vamana]], [[virechana]]'' and ''[[raktamokshana]]'' for the patient suffering from ''[[vata]]-gulma'' have been described.

−

For the treatment of ''pitta gulma'', ''sarpi'' prepared with ''tikta'' drugs, ''kshira, samshamana-niruha basti'', bloodletting, counseling (''ashvasana''), ''samshamana''(preparations) have been described.

+

For the treatment of ''[[pitta]] gulma'', ''sarpi'' prepared with ''tikta'' drugs, ''kshira, samshamana-niruha [[basti]]'', bloodletting, counseling (''ashvasana''), ''samshamana''(preparations) have been described.

For ''pakva'' (suppurated) ''gulma'', surgical procedure and poultice (''upanaha'') are described and for that which is ruptured internally the purification (''samshodhana'') and palliative (''samshamana'') treatments are mentioned.

−

For ''kapha gulma, snehana, swedana, bhedana, langhana, vamana, virechana, ~~sarpirbasti~~, gutika, churna, arishta, kshara,'' bloodletting followed by cauterization of the ''gulma'' as a last resort have been described. Line of treatment for ''rakta-guma'' occurring in women has also been described.

+

For ''[[kapha]] gulma, [[snehana]], [[swedana]], bhedana, [[langhana]], [[vamana]], [[virechana]], sarpir[[basti]], gutika, churna, arishta, kshara,'' bloodletting followed by cauterization of the ''gulma'' as a last resort have been described. Line of treatment for ''[[]rakta]]-guma'' occurring in women has also been described.

−

Use of wholesome (''pathya'') eats and drinks, avoidance of the respective etiological factors, continuously protection of digestive power (''agni''), the instruction for the patient who has undergone ''snehana'' are described.

+

Use of wholesome (''pathya'') eats and drinks, avoidance of the respective etiological factors, continuously protection of digestive power (''agni''), the instruction for the patient who has undergone ''[[snehana]]'' are described.

Etiological factors, signs and symptoms, successful line of treatment, curability and otherwise and therapeutic measures are described in concise form in this chapter of [[Gulma Chikitsa]] as described by Agnivesha [183-189]

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== Tattva Vimarsha (Fundamental Principles) ==

−

*''Gulma'' occurs predominantly due to excessive excretion of feces, ''kapha'' and ''pitta'' or due to pressure exerted by their excessive aggravation and other causes leading to vitiation of ''vata dosha''.

+

*''Gulma'' occurs predominantly due to excessive excretion of feces, ''[[kapha]]'' and ''[[pitta]]'' or due to pressure exerted by their excessive aggravation and other causes leading to vitiation of ''[[vata dosha]]''.

*Cavities like that in urinary bladder (hypo gastric region), umbilical region (''nabhi''), cardiac region (''hridi'') and two flanks (''parshva'') are susceptible sites for ''gulma''.

−

*All ''gulma'' are treated after consideration of ''dosha'' dominance, stage, site and strength of patient.

+

*All ''gulma'' are treated after consideration of ''[[dosha]]'' dominance, stage, site and strength of patient.

−

*Internal administration of ''sneha'' (unctuous substance) in various modes like oral administration, massage, unctuous enema is the principle of management of ''vata'' dominant ''gulma''.

+

*Internal administration of ''sneha'' (unctuous substance) in various modes like oral administration, massage, unctuous enema is the principle of management of ''[[vata]]'' dominant ''gulma''.

−

*If ''pitta gulma'' is caused due to unctuous and hot substances, then ''virechana'' shall be administered. If it is caused by dry and hot substances, then ghee shall be administered.

+

*If ''[[pitta]] gulma'' is caused due to unctuous and hot substances, then ''[[virechana]]'' shall be administered. If it is caused by dry and hot substances, then ghee shall be administered.

−

*If ''kapha-gulma'' is caused by indulgence in cold, heavy and unctuous diet and in those not eligible for ''vamana, langhana'' (depletion) therapy should be prescribed in the beginning. ''Vamana'' is indicated in a patient of ''gulma'' who is having low digestion, anorexia, nausea and mild pain, heaviness and stiffness in abdomen.

+

*If ''[[kapha]]-gulma'' is caused by indulgence in cold, heavy and unctuous diet and in those not eligible for ''[[vamana]], [[langhana]]'' (depletion) therapy should be prescribed in the beginning. ''[[Vamana]]'' is indicated in a patient of ''gulma'' who is having low digestion, anorexia, nausea and mild pain, heaviness and stiffness in abdomen.

−

*''Kapha gulma'' is treated with ''langhana, agni dipana, swedana, vamana, snehana, kshara karma'' and ''agni karma.''

+

*''[[Kapha]] gulma'' is treated with ''[[langhana]], agni [[dipana]], [[swedana]], [[vamana]], [[snehana]], kshara karma'' and ''agni karma.''

−

*If ''kapha-gulma'' has a deep root and is large in size, hard in consistency and heavy, then the patient should be treated with alkali preparation-''kshara, arishta'' and ''agni karma'' (cauterization).

+

*If ''[[kapha]]-gulma'' has a deep root and is large in size, hard in consistency and heavy, then the patient should be treated with alkali preparation-''kshara, arishta'' and ''agni karma'' (cauterization).

*With decrease in digestive-power (''agni'') the ''gulma'' is aggravated, while on augmentation of the digestion (''agni'') the ''gulma'' is pacified. Therefore, to the patient of ''gulma'' neither excessive nutritional food nor excessive fasting or light food/treatment should be prescribed (112).

*''Pitta gulma'' requires immediate treatment (''atyayika'') and the patient should be given ghee prepared with purgative and bitter drugs (114).

−

*Equilibrium or provocation of all the ''dosha'' depend upon the condition of ''agni'' (digestion and metabolism), hence one should always take its care and avoid such causes which disturb it.

+

*Equilibrium or provocation of all the ''[[dosha]]'' depend upon the condition of ''agni'' (digestion and metabolism), hence one should always take its care and avoid such causes which disturb it.

−

*''Vamana karma'' should be done in ''kapha gulma'' provided the patient is fit for it.

+

*''[[Vamana]] karma'' should be done in ''[[kapha]] gulma'' provided the patient is fit for it.

*The excessively increased stage of ''gulma'' needs surgical intervention.

*The ''gulma'' which gradually goes on increasing, spreading over a large area, has taken firm root, is covered by veins, has convex surface like that of tortoise, and which is accompanied with weakness, anorexia, thirst, nausea, vomiting, fever, cough, coryza and drowsiness is considered malignant and as incurable.

−

*''Rakta gulma'' should be treated only after observation for 10 months. This waiting period is essential for achieving a stage suitable for intervention. The patient should be given unctuous ''virechana'' after preparing with ''snehana'' and ''swedana''.

+

*''[[Rakta]] gulma'' should be treated only after observation for 10 months. This waiting period is essential for achieving a stage suitable for intervention. The patient should be given unctuous ''[[virechana]]'' after preparing with ''[[snehana]]'' and ''[[swedana]]''.

== Vidhi Vimarsha (Applied Inferences ) ==

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In [[Ayurveda]], a comprehensive description is given for abdominal swellings. While the generalized swellings have been described under the heading of ''udara roga'' (ascites), localized inflammatory swellings are described under the heading of ''vidradhi''. However, there are other varieties of localized abdominal lumps which are non inflammatory in nature and are considered primarily under the heading of ''gulma''.

−

On analyzing the features described by Charak, it appears that the ''vataja gulma'' are irregular, mobile swellings of waxing and waning nature and are associated with pain of different characters. Such features can be seen in conditions like chronic intestinal obstructions of various etiology, intestinal tuberculosis, pyloric stenosis, mobile caecum etc. The treatment modalities like ''snehana, swedana'' and ''basti/vamana'' help in alleviating the symptoms by elimination of feces and flatus as well as improving the gut motility.

+

On analyzing the features described by Charak, it appears that the ''vataja gulma'' are irregular, mobile swellings of waxing and waning nature and are associated with pain of different characters. Such features can be seen in conditions like chronic intestinal obstructions of various etiology, intestinal tuberculosis, pyloric stenosis, mobile caecum etc. The treatment modalities like ''[[snehana]], [[swedana]]'' and ''[[basti]]/[[vamana]]'' help in alleviating the symptoms by elimination of feces and flatus as well as improving the gut motility.

''Pittaja gulma'' have been described as tender abdominal lumps associated with fever, thirst, burning sensation etc. which usually progress through various stages of inflammation i.e. ''ama-avastha'' and ''pachyamana avastha'' and finally suppurate.

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In addition to above varieties of ''gulma'', a ''tridoshaja gulma'' is also described which is considered as incurable. The features described like an elevated, stony hard lump with excessive pain and burning sensation and loss of vitality suggest more towards a malignant tumor of the abdomen. Moreover, the bad prognostic characters defined for an incurable ''gulma'' viz. a gradually increasing, deep rooted, elevated hard mass like a turtle shell which is associated with visibly engorged vessels and poor general condition like generalized edema, loss of appetite, cough, vomiting, persistent fever etc. point more towards an advanced malignant lesion of abdomen e.g. hepatoma or the metastatic involvement of liver or other solid malignant tumors of abdominal organs.

−

In conclusion, ''~~vataja~~ gulma'' are mobile swellings of waxing and waning nature due to partial obstructive lesions of gut lumen. ''~~Pittaja~~ gulma'' are intraperitoneal or extraperitoneal inflammatory or suppurative lesions of abdomen whereas ''~~kaphaja~~ gulma'' are non inflammatory benign lesions of abdominal wall. ''Tridoshaja gulma'' seems to be malignant intra-abdominal lesions with poor prognosis.

+

In conclusion, ''[[vata]]ja gulma'' are mobile swellings of waxing and waning nature due to partial obstructive lesions of gut lumen. ''[[Pitta]]ja gulma'' are intraperitoneal or extraperitoneal inflammatory or suppurative lesions of abdomen whereas ''[[kapha]]ja gulma'' are non inflammatory benign lesions of abdominal wall. ''Tridoshaja gulma'' seems to be malignant intra-abdominal lesions with poor prognosis.

=== Sites of ''gulma'' ===

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[[Ayurveda]] is a clinical science; therefore, the diseases are classified in such a way so that they can be systematically diagnosed on the basis of the symptoms. ''Gulma'' is a good example for it.

−

Mainly three resembling diseases occur in the abdominal cavity viz. ''udara roga, gulma'' and ''pliha dosha'' which require differential diagnosis. ''Udararoga'' comprises of eight diseases which cause general enlargement of the abdomen. Five types of ''gulma'' have protruding and palpable localized swellings related to the abdominal organs and appendages. Under ''pliha dosha'' benign enlargement of spleen or liver occurs ~~(''~~Bhavaprakasha Chikitsa-Prakarana'' chapter 33). Therefore, on the basis of these clear demarcations, it may not be difficult to differentiate these three kinds of diseases clinically.

+

Mainly three resembling diseases occur in the abdominal cavity viz. ''udara roga, gulma'' and ''pliha dosha'' which require differential diagnosis. ''Udararoga'' comprises of eight diseases which cause general enlargement of the abdomen. Five types of ''gulma'' have protruding and palpable localized swellings related to the abdominal organs and appendages. Under ''pliha dosha'' benign enlargement of spleen or liver occurs <ref>Bhavamishra. Bhavaprakasha -Volume I.Chikitsa-Prakarana chapter 33, Translated from Sanskrit by K.R. Srikantha Murthy. 1st ed. Varanasi: Krishnadas academy;2000.pp.-</ref>. Therefore, on the basis of these clear demarcations, it may not be difficult to differentiate these three kinds of diseases clinically.

=== ''Chikitsa sutra'' (principles of management) of ''gulma'' ===

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'''Principles''':

#''Anulomana''

−

#''Pachana''

+

#''[[Pachana]]''

'''Main drugs''':

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! scope="col"| ''Anupana''

|-

−

| rowspan="3"| ''Vata'' dominant

+

| rowspan="3"| ''[[Vata]]'' dominant

| ''Lashunadi Vati''

| 500 to 1000 mg

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| Milk

|-

−

| rowspan="3"| ''Pitta'' dominant

+

| rowspan="3"| ''[[Pitta]]'' dominant

| ''Praval panchamritam''

| 250 to 500 mg

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| Milk

|-

−

| rowspan="3"| ''Kapha'' dominant

+

| rowspan="3"| ''[[Kapha]]'' dominant

| ''Svarna vasant''

| 250 to 500 mg

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| ''Kumaryasava''

|-

−

| rowspan="2"| ''~~Raktaja~~''

+

| rowspan="2"| ''[[Rakta]]ja''

| ''Shatavari-truna panchamula decoction ''

| 20 to 40 ml

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! scope="col"| ''Anupana''

|-

−

| rowspan="2"| ''Virechana''

+

| rowspan="2"| ''[[Virechana]]''

| Castor Oil

| 20-40 ml

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| Milk

|-

−

| ''Virechana'' decoction

+

| ''[[Virechana]]'' decoction

| 20-40 ml

| Morning, one time

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=== Further reading ===

−

#~~Bhavaprakasha: Bhavaprakasha . Published by Chaukhambha Sanskrit Series office Banaras~~. ~~Cikitsa Prakarana~~

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#Charak. Charak Samhita. Edited by Jadavaji Trikamji Aacharya. 1st ed. Varanasi: Krishnadas Academy;2000. p.--.

−

~~#Charak:~~ Charak Samhita, Edited by ~~Yadavaji T~~. ~~Acharya~~. ~~Niranaya sagar Press, Bombay~~.

+

#Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--

−

#Madhava: ~~Madhava Nidana~~; ~~published by Chaukhamba Samskrit series office, Varanasi,~~

+

#Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.--.

−

#Sushruta: Sushruta Samhita. Edited by ~~Yadavaji T~~. ~~Acharya~~. ~~Niranaya sagar Press, Bombay~~.

+

#Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.p.--.

−

#Vagbhata ~~Junior~~: ~~Ashtanga Hridaya with Sarvanga~~-~~Sundra commentry~~ by ~~Arunadatta, published by Chaukhamba Samskrit series office,~~ Varanasi,

+

#Bhavamishra. Bhavaprakasha -Volume I. Translated from Sanskrit by K.R. Srikantha Murthy. 1st ed. Varanasi: Krishnadas academy;2000.pp.-

#Warner E. C. (1964): Savill's System of clinical medicine. Orient Longmans Ltd.New Delhi, 14th Edition p.341

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