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{{#seo:
|title=Gulma Nidana
|titlemode=append
|keywords=Gulma, mahasrotas, koshtha, dhatukshaya, avarana, abdominal lumps, intra-abdominal swellings, tumors", Ayurveda, Indian system of medicine, charak samhita.
|description=Nidana Sthana Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
}}
<big>'''Nidana Sthana Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps '''</big>
{{Infobox
{{Infobox
|title = Gulma Nidana
|title = Gulma Nidana
|label4 = Other Sections
|label4 = Other Sections
|data4 = [[Sutra Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data4 = [[Sutra Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|header3 =
|data6 = Sahu M., Fatmi U., [[Yogesh Deole|Deole Y. S.]]
|label7 = Reviewer
|data7 = Kar A.C., Gadgil D.
|label8 = Editors
|data8 = Khandel S.K., Godatwar P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s02.004 10.47468/CSNE.2020.e01.s02.004]
}}
}}
==([[Nidana Sthana]] Chapter 3, Chapter on Abdominal lumps)==
<big>'''Abstract'''</big>
<p style="text-align:justify;">The third chapter describes the etiology, pathogenesis, clinical features and therapeutics of lumps in abdomen. Gulma, a (stable or transitory) growth that could occur anywhere in the body is primarily caused by a vitiated [[vata]]. The description given in the text cannot be correlated with any single entity of conventional medicine, but denotes localized intra-abdominal swellings of multiple origin in terms of their cause, site, features etc. In patients weakened by or recuperating from diseases or cleansing therapies ([[vamana]], etc.), or suffering from very stressful conditions, [[vata]] gets vitiated and enters the mahasrotas (gastrointestinal tract) causing the formation of gulma. Amongst the five types of gulma, sannipatika gulma is incurable whereas remaining can be managed according to [[dosha]] involvement. </p>
'''Keywords''': ''Gulma, mahasrotas, koshtha, dhatukshaya, avarana'', abdominal lumps, intra-abdominal swellings, tumors.
</div>
== Introduction ==
=== Introduction ===
<div style="text-align:justify;">
The word ''gulma'' is derived from the Sanskrit root ''gud'', literal meaning encircling or surrounding. Therefore the word ''gulma'' stands for an entity that encircles, envelops or covers something. According to mythological concepts described in this text, people fleeing from the wrath of Lord Shiva, when he was dismantling Daksha’s holy sacrifice, were afflicted with this disease. This legend is symbolic, since situations such as panic, stress, or grief, usually accompanying such a chaotic, cataclysmic event would lead to vitiation of ''[[vata]]'' causing the appearance of ''[[vata]]''-dominant diseases like ''gulma'', etc. In [[Ayurveda]], ''gulma'' has been defined as large palpable, rounded, intra- abdominal swellings between ''hridaya'' (upper abdomen) and the ''basti'' (bladder) regions, which develop due to accumulation of ''[[dosha]]s'' with predominance of ''[[vata]]''. Such swellings are either transitory or static, and display the properties of spontaneous regression and reappearance. ''Gulmas'' are usually non-suppurative and are separate entities from other intra-abdominal swellings such as ''antar vidradhi'' (internal abscesses) where suppuration is often found.
The word ''gulma'' is derived from the Sanskrit root ''gud'', literal meaning encircling or surrounding. Therefore the word ''gulma'' stands for an entity that encircles, envelops or covers something. According to mythological concepts described in this text, people fleeing from the wrath of Lord Shiva, when he was dismantling Daksha’s holy sacrifice, were afflicted with this disease. This legend is symbolic, since situations such as panic, stress, or grief, usually accompanying such a chaotic, cataclysmic event would lead to vitiation of ''vata'' causing the appearance of ''vata''-dominant diseases like ''gulma'', etc. In [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], ''gulma'' has been defined as large palpable, rounded, intra- abdominal swellings between ''hridaya'' (upper abdomen) and the ''basti'' (bladder) regions, which develop due to accumulation of ''doshas'' with predominance of ''vata''. Such swellings are either transitory or static, and display the properties of spontaneous regression and reappearance. ''Gulmas'' are usually non-suppurative and are separate entities from other intra-abdominal swellings such as ''antar vidradhi'' (internal abscesses) where suppuration is often found.
The vitiated ''[[vata]]'', in conjunction with other ''[[dosha]]s'', gets into the ''mahasrotas'' and get lodged either in the ''amashaya'' (stomach), ''pittashaya'' (gallbladder), ''pakwashaya'' (cecum) or in other regions like ''hridaya'' (epigastric), ''basti'' (bladder) and ''nabhi'' (umblicus) leading to formation of deep-rooted shrub-like mass. Here a new term has been introduced i,e, ''mahasrotas'', that could be explained as viscera including organs of the gastrointestinal tract. However, commentators have suggested that it stands for all of abdominal viscera, including the kidneys. Thus it is evident that under the definition of ''mahasrotas'' all the organs in abdomen are included. 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:
*''Hridaya'' (epigastric region),
*''Hridaya'' (epigastric region),
Besides these, there is a fifth type afflicting only women - ''shonitaja gulma'' of the ''yoni'' region i.e. in the ''garbhashaya'' or uterus region. Such ''gulma'' shows a progressive increase in size and thus requires a special attention to differentiate it from pregnancy.
Besides these, there is a fifth type afflicting only women - ''shonitaja gulma'' of the ''yoni'' region i.e. in the ''garbhashaya'' or uterus region. Such ''gulma'' shows a progressive increase in size and thus requires a special attention to differentiate it from pregnancy.
While there are ''gulma'' variants like ''paittika'' and ''kaphaja gulma'' caused by an excess of ''pitta'' and ''kapha'' respectively, it is essentially a ''vata'' disorder. ''Sannipatika gulma'' is caused due to the vitiation of all the three ''doshas''. Since abdominal organs have ''mamsadhatu'' as the main component, all the ''siragranthi'' (glandular/tumorous) types of ''srotodushti'' (vitiation of channels carrying body components) of abdominal viscera have also been covered under ''gulma''. This chapter also covers obstruction and inflammation of viscera having no swelling.
While there are ''gulma'' variants like ''paittika'' and ''kaphaja gulma'' caused by an excess of ''[[pitta]]'' and ''[[kapha]]'' respectively, it is essentially a ''[[vata]]'' disorder. ''Sannipatika gulma'' is caused due to the vitiation of all the three ''[[dosha]]s''. Since abdominal organs have ''[[mamsa dhatu]]'' as the main component, all the ''siragranthi'' (glandular/tumorous) types of ''srotodushti'' (vitiation of channels carrying body components) of abdominal viscera have also been covered under ''gulma''. This chapter also covers obstruction and inflammation of viscera having no swelling.
</div>
==Sanskrit Text, Transliteration and English Translation==
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अथातो गुल्मनिदानं व्याख्यास्यामः||१||
अथातो गुल्मनिदानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
इति ह स्माह भगवानात्रेयः||२||
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athātō gulmanidānaṁ vyākhyāsyāmaḥ||1||
athātō gulmanidānaṁ vyākhyāsyāmaḥ||1||
Iti ha smAha bhagavAnAtreyaH||2||
Iti ha smAha bhagavAnAtreyaH||2||
</div></div>
Now I shall explain the chapter on etiopathogenesis of ''gulma''. Thus said Lord Atreya.[1-2]
Now we shall expound the chapter "Gulma Nidana"(Diagnosis and etio-pathogenesis of Abdominal lumps). Thus said Lord Atreya.[1-2]
=== Classification of ''gulma'' ===
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इह खलु पञ्च गुल्मा भवन्ति; तद्यथा- वातगुल्मः, पित्तगुल्मः,
इह खलु पञ्च गुल्मा भवन्ति; तद्यथा- वातगुल्मः, पित्तगुल्मः,
श्लेष्मगुल्मो, निचयगुल्मः, शोणितगुल्म इति||३||
श्लेष्मगुल्मो, निचयगुल्मः, शोणितगुल्म इति||३||
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iha khalu pañca gulmā bhavanti; tadyathā- vātagulmaḥ, pittagulmaḥ, ślēṣmagulmō, nicayagulmaḥ, śōṇitagulma iti||3||
iha khalu pañca gulmā bhavanti; tadyathā- vātagulmaḥ, pittagulmaḥ, ślēṣmagulmō, nicayagulmaḥ, śōṇitagulma iti||3||
Iha khalu pa~jca gulma bhavanti; tadyathA- VatagulmaH, pittagulmaH, shleShmagulmo, nicaya gulmaH, shoNitagulma iti||3||
Iha khalu pa~jca gulma bhavanti; tadyathA- VatagulmaH, pittagulmaH, shleShmagulmo, nicaya gulmaH, shoNitagulma iti||3||
</div></div>
There are five types of ''gulma''- ''vata'' dominant ''gulma'', ''pitta'' dominant ''gulma'', ''shleshma''/''kapha'' dominant ''gulma'', ''nichaya'' (''tridosha'' dominant) ''gulma'', and ''shonita gulma''.[3]
There are five types of ''gulma''- ''[[vata]]'' dominant ''gulma'', ''[[pitta]]'' dominant ''gulma'', ''shleshma''/''[[kapha]]'' dominant ''gulma'', ''nichaya'' (''tridosha'' dominant) ''gulma'', and ''shonita gulma''.[3]
=== Agnivesha’s question ===
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एवंवादिनं भगवन्तमात्रेयमग्निवेश उवाच- कथमिह भगवन् पञ्चानां गुल्मानां विशेषमभिजानीमहे; नह्यविशेषविद्रोगाणामौषधविदपि भिषक् प्रशमनसमर्थो भवतीति||४||
एवंवादिनं भगवन्तमात्रेयमग्निवेश उवाच- कथमिह भगवन् पञ्चानां गुल्मानां विशेषमभिजानीमहे; नह्यविशेषविद्रोगाणामौषधविदपि भिषक् प्रशमनसमर्थो भवतीति||४||
<div class="mw-collapsible-content">
ēvaṁvādinaṁ bhagavantamātrēyamagnivēśa uvāca- kathamiha bhagavan pañcānāṁ gulmānāṁ viśēṣamabhijānīmahē; nahyaviśēṣavidrōgāṇāmauṣadhavidapibhiṣak praśamanasamarthō bhavatīti||4||
ēvaṁvādinaṁ bhagavantamātrēyamagnivēśa uvāca- kathamiha bhagavan pañcānāṁ gulmānāṁ viśēṣamabhijānīmahē; nahyaviśēṣavidrōgāṇāmauṣadhavidapibhiṣak praśamanasamarthō bhavatīti||4||
gulmanAM visheShamabhijAnImahe; nahyavisheShavidrogANAmauShadhavidapi bhiShak
gulmanAM visheShamabhijAnImahe; nahyavisheShavidrogANAmauShadhavidapi bhiShak
prashamanasamartho bhavatIti||4||
prashamanasamartho bhavatIti||4||
</div></div>
<div style="text-align:justify;">
After Lord Atreya said this, Agnivesha asked, “Sir, How can we know the specific characteristics of these five ''gulmas''? Because without this knowledge, such patients cannot be successfully treated by a physician even though he is well versed in the selection and usage of drugs.”[4]
After Lord Atreya said this, Agnivesha asked, “Sir, How can we know the specific characteristics of these five ''gulmas''? Because without this knowledge, such patients cannot be successfully treated by a physician even though he is well versed in the selection and usage of drugs.”[4]
</div>
<div class="mw-collapsible mw-collapsed">
तमुवाच भगवानात्रेयः-
तमुवाच भगवानात्रेयः-
समुत्थानपूर्वरूपलिङ्गवेदनोपशयविशेषेभ्यो विशेषविज्ञानं गुल्मानां भवत्यन्येषां च रोगाणामग्निवेश! तत्तु खलु गुल्मेषूच्यमानं निबोध||५||
समुत्थानपूर्वरूपलिङ्गवेदनोपशयविशेषेभ्यो विशेषविज्ञानं गुल्मानां भवत्यन्येषां च रोगाणामग्निवेश! तत्तु खलु गुल्मेषूच्यमानं निबोध||५||
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tamuvāca bhagavānātrēyaḥ- samutthānapūrvarūpaliṅgavēdanōpaśayaviśēṣēbhyō viśēṣavijñānaṁ gulmānāṁ bhavatyanyēṣāṁ ca rōgāṇāmagnivēśa! tattu khalu [1]gulmēṣūcyamānaṁ nibōdha||5||
tamuvāca bhagavānātrēyaḥ- samutthānapūrvarūpaliṅgavēdanōpaśayaviśēṣēbhyō viśēṣavijñānaṁ gulmānāṁ bhavatyanyēṣāṁ ca rōgāṇāmagnivēśa! tattu khalu [1]gulmēṣūcyamānaṁ nibōdha||5||
samutthAnapUrvarUpali~ggavedanopashayavisheShebhyo visheShavij~jAnaM gulmanAM
samutthAnapUrvarUpali~ggavedanopashayavisheShebhyo visheShavij~jAnaM gulmanAM
bhavatyanyeShAM ca rogANAmagnivesha! Tattu khalu gulmeShUcyamAnaM nibodha||5||
bhavatyanyeShAM ca rogANAmagnivesha! Tattu khalu gulmeShUcyamAnaM nibodha||5||
</div></div>
Lord Atreya replied, “Agnivesha! Specific characteristics of the five ''gulma'' as well as other diseases are defined on the basis of their etiology, prodromal symptoms, clinical features with various types of pains, and therapeutic applicability.”[5]
Lord Atreya replied, “Agnivesha! Specific characteristics of the five ''gulma'' as well as other diseases are defined on the basis of their etiology, prodromal symptoms, clinical features with various types of pains, and therapeutic applicability.”[5]
=== Etio-pathogenesis of ''[[vata]]''-dominant ''gulma'' ===
<div class="mw-collapsible mw-collapsed">
यदा पुरुषो वातलो विशेषेण ज्वरवमनविरेचनातीसाराणामन्यतमेन
यदा पुरुषो वातलो विशेषेण ज्वरवमनविरेचनातीसाराणामन्यतमेन
अभिघातमृच्छति वा, विषमासनशयनस्थानचङ्क्रमणसेवी
अभिघातमृच्छति वा, विषमासनशयनस्थानचङ्क्रमणसेवी
वा भवति, अन्यद्वा किञ्चिदेवंविधं विषममतिमात्रं व्यायामजातमारभते, तस्यापचाराद्वातः प्रकोपमापद्यते||६||
वा भवति, अन्यद्वा किञ्चिदेवंविधं विषममतिमात्रं व्यायामजातमारभते, तस्यापचाराद्वातः प्रकोपमापद्यते||६||
<div class="mw-collapsible-content">
yadā puruṣō vātalō viśēṣēṇa jvaravamanavirēcanātīsārāṇāmanyatamēna karśanēna karśitō vātalamāhāramāharati, śītaṁ vā viśēṣēṇātimātram [3] , asnēhapūrvē vāvamanavirēcanē pibati, anudīrṇāṁ vā chardimudīrayati, udīrṇān vātamūtrapurīṣavēgānniruṇaddhi, atyaśitō vā pibati navōdakamatimātram, atisaṅkṣōbhiṇā vā yānēnayāti, ativyavāyavyāyāmamadyaśōkarucirvā, abhighātamr̥cchati vā, viṣamāsanaśayanasthānacaṅkramaṇasēvī [4] vā bhavati, anyadvā kiñcidēvaṁvidhaṁviṣamamatimātraṁ vyāyāmajātamārabhatē, tasyāpacārādvātaḥ [5] prakōpamāpadyatē||6||
yadā puruṣō vātalō viśēṣēṇa jvaravamanavirēcanātīsārāṇāmanyatamēna karśanēna karśitō vātalamāhāramāharati, śītaṁ vā viśēṣēṇātimātram [3] , asnēhapūrvē vāvamanavirēcanē pibati, anudīrṇāṁ vā chardimudīrayati, udīrṇān vātamūtrapurīṣavēgānniruṇaddhi, atyaśitō vā pibati navōdakamatimātram, atisaṅkṣōbhiṇā vā yānēnayāti, ativyavāyavyāyāmamadyaśōkarucirvā, abhighātamr̥cchati vā, viṣamāsanaśayanasthānacaṅkramaṇasēvī [4] vā bhavati, anyadvā kiñcidēvaṁvidhaṁviṣamamatimātraṁ vyāyāmajātamārabhatē, tasyāpacārādvātaḥ [5] prakōpamāpadyatē||6||
anyadvA ki~jcidevaMvidhaM viShamamatimAtraM vyAyAmajAtamArabhate,
anyadvA ki~jcidevaMvidhaM viShamamatimAtraM vyAyAmajAtamArabhate,
tasyApacArAdVataH prakopamApadyate||6||
tasyApacArAdVataH prakopamApadyate||6||
</div></div>
When a person of ''vatika'' constitution, particularly emaciated due to one of the debilitating factors like fever, emesis, purgation and diarrhoea, consumes ''vata''- aggravating food or excessively cold food, in excessive quantities, or is administered emesis or purgation without prior unction, he vomits profusely and holds up impelling urges of flatus, urine, bowel movement. Or if such a person, after consuming a heavy meal, drinks a lot of fresh water or travels by an excessively jerking vehicle, indulges in excessive sexual intercourse, intensive physical exercise, or drinks alcoholic drinks, or suffers from excessive anxiety, or is subjected to injury or uses uneven postures in sitting, sleeping, standing and walking, or starts some other similar sort of irregular and excessive physical exercises -''vata'' gets vitiated or aggravated. [6]
<div style="text-align:justify;">
When a person of ''vatika'' constitution, particularly emaciated due to one of the debilitating factors like fever, emesis, purgation and diarrhoea, consumes ''[[vata]]''- aggravating food or excessively cold food, in excessive quantities, or is administered emesis or purgation without prior unction, he vomits profusely and holds up impelling urges of flatus, urine, bowel movement. Or if such a person, after consuming a heavy meal, drinks a lot of fresh water or travels by an excessively jerking vehicle, indulges in excessive sexual intercourse, intensive physical exercise, or drinks alcoholic drinks, or suffers from excessive anxiety, or is subjected to injury or uses uneven postures in sitting, sleeping, standing and walking, or starts some other similar sort of irregular and excessive physical exercises -''[[vata]]'' gets vitiated or aggravated. [6]
</div>
<div class="mw-collapsible mw-collapsed">
स प्रकुपितो वायुर्महास्रोतोऽनुप्रविश्य रौक्ष्यात्
स प्रकुपितो वायुर्महास्रोतोऽनुप्रविश्य रौक्ष्यात्
भवति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत
भवति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत
इति वातगुल्मः||७||
इति वातगुल्मः||७||
<div class="mw-collapsible-content">
sa prakupitō vāyurmahāsrōtō'nupraviśya raukṣyāt kaṭhinībhūtamāplutya [6] piṇḍitō'vasthānaṁ karōti hr̥di bastau pārśvayōrnābhyāṁ vā; sa śūlamupajanayatigranthīṁścānēkavidhān, piṇḍitaścāvatiṣṭhatē, sa piṇḍitatvād ‘gulma’ ityabhidhīyatē; sa muhurādhamati [7] , muhuralpatvamāpadyatē; aniyatavipulāṇuvēdanaścabhavati calatvādvāyōḥ, muhuḥ pipīlikāsampracāra ivāṅgēṣu, tōdabhēdasphuraṇāyāmasaṅkōcasuptiharṣapralayōdayabahulaḥ; tadāturaḥ sūcyēva śaṅkunēvacābhisaṁviddhamātmānaṁ manyatē, api ca divasāntē jvaryatē [8] , śuṣyati cāsyāsyam, ucchvāsaścōparudhyatē, hr̥ṣyanti cāsya rōmāṇi vēdanāyāḥ prādurbhāvē;plīhāṭōpāntrakūjanāvipākōdāvartāṅgamardamanyāśiraḥśaṅkhaśūlabradhnarōgāścainamupadravanti; kr̥ṣṇāruṇaparuṣatvaṅnakhanayanavadanamūtrapurīṣaścabhavati, nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti vātagulmaḥ||7||
sa prakupitō vāyurmahāsrōtō'nupraviśya raukṣyāt kaṭhinībhūtamāplutya [6] piṇḍitō'vasthānaṁ karōti hr̥di bastau pārśvayōrnābhyāṁ vā; sa śūlamupajanayatigranthīṁścānēkavidhān, piṇḍitaścāvatiṣṭhatē, sa piṇḍitatvād ‘gulma’ ityabhidhīyatē; sa muhurādhamati [7] , muhuralpatvamāpadyatē; aniyatavipulāṇuvēdanaścabhavati calatvādvāyōḥ, muhuḥ pipīlikāsampracāra ivāṅgēṣu, tōdabhēdasphuraṇāyāmasaṅkōcasuptiharṣapralayōdayabahulaḥ; tadāturaḥ sūcyēva śaṅkunēvacābhisaṁviddhamātmānaṁ manyatē, api ca divasāntē jvaryatē [8] , śuṣyati cāsyāsyam, ucchvāsaścōparudhyatē, hr̥ṣyanti cāsya rōmāṇi vēdanāyāḥ prādurbhāvē;plīhāṭōpāntrakūjanāvipākōdāvartāṅgamardamanyāśiraḥśaṅkhaśūlabradhnarōgāścainamupadravanti; kr̥ṣṇāruṇaparuṣatvaṅnakhanayanavadanamūtrapurīṣaścabhavati, nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti vātagulmaḥ||7||
plIhATopAntrakUjanAvipAkodAvartA~ggamardamanyAshiraHsha~gkhashUlabradhnarogAshcainamupadravanti; kRuShNAruNaparuShatva~gnakhanayanavadanamUtrapurIShashca
plIhATopAntrakUjanAvipAkodAvartA~ggamardamanyAshiraHsha~gkhashUlabradhnarogAshcainamupadravanti; kRuShNAruNaparuShatva~gnakhanayanavadanamUtrapurIShashca
bhavati, nidAnoktAni cAsya nopasherate, viparItAni copasherata iti VatagulmaH||7||
bhavati, nidAnoktAni cAsya nopasherate, viparItAni copasherata iti VatagulmaH||7||
</div></div>
Such vitiated ''vata'', on entering the ''mahasrotas'', hardens due to dryness forming a mass or swelling localised in the regions of heart, urinary bladder, sides and the navel. The condition, ''gulma'' (or ''vata gulma''), is painful and can take the shape of a single swelling or multiple nodules of various types. It sometimes gets aggravated and enlarged, sometimes diminished, and causes mild or severe pain due to instability of ''vayu''. Sometimes there are tingling sensations like ants crawling on body and frequent onset and diminution of various types of painful sensations such as piercing, breaking, twitching, extension, contraction, numbness, hyperaesthesia, etc. These sensations could be accompanied by a rise in temperature usually in the evenings, dryness of mouth, difficulty in expiration, horripilation at the onset of pain and complications such as spleen (enlargement), distension and gurgling sound in the abdomen, indigestion, ''udavarta'' (upward movement of ''vata''), bodyache, pain in the lateral side of the neck, head and temple regions and ''bradhana'' (swellings of the inguinal region) with appearance of blackness, reddishness and roughness in skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. These are characteristic features of ''vata gulma''. [7]
<div style="text-align:justify;">
Such vitiated ''[[vata]]'', on entering the ''mahasrotas'', hardens due to dryness forming a mass or swelling localised in the regions of heart, urinary bladder, sides and the navel. The condition, ''gulma'' (or ''[[vata]] gulma''), is painful and can take the shape of a single swelling or multiple nodules of various types. It sometimes gets aggravated and enlarged, sometimes diminished, and causes mild or severe pain due to instability of ''[[vayu]]''. Sometimes there are tingling sensations like ants crawling on body and frequent onset and diminution of various types of painful sensations such as piercing, breaking, twitching, extension, contraction, numbness, hyperaesthesia, etc. These sensations could be accompanied by a rise in temperature usually in the evenings, dryness of mouth, difficulty in expiration, horripilation at the onset of pain and complications such as spleen (enlargement), distension and gurgling sound in the abdomen, indigestion, ''udavarta'' (upward movement of ''[[vata]]''), bodyache, pain in the lateral side of the neck, head and temple regions and ''bradhana'' (swellings of the inguinal region) with appearance of blackness, reddishness and roughness in skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. These are characteristic features of ''[[vata]] gulma''. [7]
</div>
=== ''[[Pitta]]''-dominant ''gulma'' ===
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तैरेव तु कर्शनैः कर्शितस्याम्ललवणकटुकक्षारोष्ण तीक्ष्ण शुक्तव्यापन्न मद्यहरितकफलाम्लानां विदाहिनां च शाकधान्य मांसादीनामुपयोगादजीर्णाध्यशनाद्रौक्ष्यानुगते चामाशये वमनमतिवेलं सन्धारणं वातातपौ चातिसेवमानस्य पित्तं सह मारुतेन प्रकोपमापद्यते||८||
तैरेव तु कर्शनैः कर्शितस्याम्ललवणकटुकक्षारोष्ण तीक्ष्ण शुक्तव्यापन्न मद्यहरितकफलाम्लानां विदाहिनां च शाकधान्य मांसादीनामुपयोगादजीर्णाध्यशनाद्रौक्ष्यानुगते चामाशये वमनमतिवेलं सन्धारणं वातातपौ चातिसेवमानस्य पित्तं सह मारुतेन प्रकोपमापद्यते||८||
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tairēva tu karśanaiḥ karśitasyāmlalavaṇakaṭukakṣārōṣṇatīkṣṇaśuktavyāpannamadyaharitakaphalāmlānāṁ vidāhināṁ caśākadhānyamāṁsādīnāmupayōgādajīrṇādhyaśanādraukṣyānugatē cāmāśayē vamanamativēlaṁ [10] sandhāraṇaṁ vātātapau cātisēvamānasya pittaṁ sahamārutēna prakōpamāpadyatē||8||
tairēva tu karśanaiḥ karśitasyāmlalavaṇakaṭukakṣārōṣṇatīkṣṇaśuktavyāpannamadyaharitakaphalāmlānāṁ vidāhināṁ caśākadhānyamāṁsādīnāmupayōgādajīrṇādhyaśanādraukṣyānugatē cāmāśayē vamanamativēlaṁ [10] sandhāraṇaṁ vātātapau cātisēvamānasya pittaṁ sahamārutēna prakōpamāpadyatē||8||
Taireva tu karshanaiH karshitasyAmlalavaNa kaTukakShAroShNatIkShNashuktavy ApannamadyaharitakaphalAmlAnAM vidAhinAM ca shAkadhAnyamAMsAdIn AmupayogAdajIrNAdhyashanAdraukShyAnugate cAmAshaye vamanamativelaM
Taireva tu karshanaiH karshitasyAmlalavaNa kaTukakShAroShNatIkShNashuktavy ApannamadyaharitakaphalAmlAnAM vidAhinAM ca shAkadhAnyamAMsAdIn AmupayogAdajIrNAdhyashanAdraukShyAnugate cAmAshaye vamanamativelaM
sandhAraNaM Vatatapau cAtisevamAnasya pittaM saha mArutena prakopamApadyate||8||
sandhAraNaM Vatatapau cAtisevamAnasya pittaM saha mArutena prakopamApadyate||8||
</div></div>
If a person, weakened by ailments or various etiological factors (as mentioned above in verse 6), uses sour, salty, pungent, and alkaline substances with hot and sharp potency, vinegar, improperly prepared or denatured alcoholic drinks, salads, sour fruits and acidic vegetables, grains, meat etc., takes food during indigestion, is administered emesis when ''amashaya'' is dry (or not properly oleated), suppresses natural urges for long, or is exposed excessively to the sun and wind, his ''pitta'' along with ''vata'' gets vitiated or aggravated. [8]
<div style="text-align:justify;">
If a person, weakened by ailments or various etiological factors (as mentioned above in verse 6), uses sour, salty, pungent, and alkaline substances with hot and sharp potency, vinegar, improperly prepared or denatured alcoholic drinks, salads, sour fruits and acidic vegetables, grains, meat etc., takes food during indigestion, is administered emesis when ''amashaya'' is dry (or not properly oleated), suppresses natural urges for long, or is exposed excessively to the sun and wind, his ''[[pitta]]'' along with ''[[vata]]'' gets vitiated or aggravated. [8]
</div>
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तत् प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति,
तत् प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति,
गुल्मावकाशश्चास्य दह्यते दूयते धूप्यते ऊष्मायते स्विद्यति क्लिद्यति शिथिल इव स्पर्शासहोऽल्परोमाञ्चश्च भवति; ज्वरभ्रमदवथुपिपासागलतालुमुखशोषप्रमोहविड्भेदाश्चैनमुपद्रवन्ति;
गुल्मावकाशश्चास्य दह्यते दूयते धूप्यते ऊष्मायते स्विद्यति क्लिद्यति शिथिल इव स्पर्शासहोऽल्परोमाञ्चश्च भवति; ज्वरभ्रमदवथुपिपासागलतालुमुखशोषप्रमोहविड्भेदाश्चैनमुपद्रवन्ति;
हरितहारिद्रत्वङ्नखनयनवदनमूत्रपुरीषश्च भवति; निदानोक्तानि चास्य नोपशेरते, विपरीतान्युपशेरत इति पित्तगुल्मः||९||
हरितहारिद्रत्वङ्नखनयनवदनमूत्रपुरीषश्च भवति; निदानोक्तानि चास्य नोपशेरते, विपरीतान्युपशेरत इति पित्तगुल्मः||९||
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tat prakupitaṁ māruta āmāśayaikadēśē saṁvartya [11] tānēva vēdanāprakārānupajanayati, ya uktā vātagulmē; pittaṁ tvēnaṁ vidahati kukṣau hr̥dyurasi kaṇṭhē ca; savidahyamānaḥ sadhūmamivōdgāramudgiratyamlānvitaṁ, gulmāvakāśaścāsya dahyatē dūyatē dhūpyatē [12] ūṣmāyatē svidyati klidyati śithila [13] ivasparśāsahō'lparōmāñcaśca [14] bhavati; jvarabhramadavathupipāsāgalatālumukhaśōṣapramōhaviḍbhēdāścainamupadravanti;haritahāridratvaṅnakhanayanavadanamūtrapurīṣaśca bhavati; nidānōktāni cāsya nōpaśēratē, viparītānyupaśērata iti pittagulmaḥ||9||
tat prakupitaṁ māruta āmāśayaikadēśē saṁvartya [11] tānēva vēdanāprakārānupajanayati, ya uktā vātagulmē; pittaṁ tvēnaṁ vidahati kukṣau hr̥dyurasi kaṇṭhē ca; savidahyamānaḥ sadhūmamivōdgāramudgiratyamlānvitaṁ, gulmāvakāśaścāsya dahyatē dūyatē dhūpyatē [12] ūṣmāyatē svidyati klidyati śithila [13] ivasparśāsahō'lparōmāñcaśca [14] bhavati; jvarabhramadavathupipāsāgalatālumukhaśōṣapramōhaviḍbhēdāścainamupadravanti;haritahāridratvaṅnakhanayanavadanamūtrapurīṣaśca bhavati; nidānōktāni cāsya nōpaśēratē, viparītānyupaśērata iti pittagulmaḥ||9||
haritahAridratva~gnakhanayanavadanamUtrapurIShashca bhavati; nidAnoktAni
haritahAridratva~gnakhanayanavadanamUtrapurIShashca bhavati; nidAnoktAni
cAsya nopasherate, viparItAnyupasherata iti pittagulmaH||9||
cAsya nopasherate, viparItAnyupasherata iti pittagulmaH||9||
</div></div>
Aggravated ''vata'', along with vitiated ''pitta'', gets (completely or partially) collected in the ''amashaya'' and produces the same types of pain as mentioned for ''vata gulma''. Due to aggravation of ''pitta'' in certain cases, the patient feels a burning sensation (with hyperacidity) in the belly, cardiac region, chest and throat while letting out smoky and sour eructations at the same time. In the location of ''gulma'', there is burning sensation, pain, sensations of fuming, sweating and moistening, laxity, tenderness and slight horripilation. The patient could exhibit symptoms such as fever, giddiness, burning pain, thirst, dryness of throat, palate and mouth, fainting and diarrhea, and develops greenish or yellowish discoloration of skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. This variant of ''gulma'' is called ''pitta gulma''. [9]
<div style="text-align:justify;">
Aggravated ''[[vata]]'', along with vitiated ''[[pitta]]'', gets (completely or partially) collected in the ''amashaya'' and produces the same types of pain as mentioned for ''[[vata]] gulma''. Due to aggravation of ''[[pitta]]'' in certain cases, the patient feels a burning sensation (with hyperacidity) in the belly, cardiac region, chest and throat while letting out smoky and sour eructations at the same time. In the location of ''gulma'', there is burning sensation, pain, sensations of fuming, sweating and moistening, laxity, tenderness and slight horripilation. The patient could exhibit symptoms such as fever, giddiness, burning pain, thirst, dryness of throat, palate and mouth, fainting and diarrhea, and develops greenish or yellowish discoloration of skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. This variant of ''gulma'' is called ''[[pitta]] gulma''. [9]
</div>
=== ''[[Kapha]]''-dominant ''gulma'' ===
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तैरेव तु कर्शनैः कर्शितस्यात्यशनादतिस्निग्धगुरुमधुरशीताशनात्
तैरेव तु कर्शनैः कर्शितस्यात्यशनादतिस्निग्धगुरुमधुरशीताशनात्
पिष्टेक्षुक्षीरतिलमाषगुडविकृतिसेवनान्मन्दकमद्यातिपानाद्धरितकातिप्रणनयादानूपौदकग्राम्यमांसातिभक्षणात् सन्धारणादबुभुक्षस्य चातिप्रगाढमुदपानात्
पिष्टेक्षुक्षीरतिलमाषगुडविकृतिसेवनान्मन्दकमद्यातिपानाद्धरितकातिप्रणनयादानूपौदकग्राम्यमांसातिभक्षणात् सन्धारणादबुभुक्षस्य चातिप्रगाढमुदपानात्
सङ्क्षोभणाद्वा शरीरस्य श्लेष्मा सह मारुतेन प्रकोपमापद्यते||१०||
सङ्क्षोभणाद्वा शरीरस्य श्लेष्मा सह मारुतेन प्रकोपमापद्यते||१०||
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tairēva tu karśanaiḥ karśitasyātyaśanādatisnigdhagurumadhuraśītāśanātpiṣṭēkṣukṣīratilamāṣaguḍavikr̥tisēvanānmandakamadyātipānāddharitakātipraṇanayādānūpaudakagrāmyamāṁsātibhakṣaṇāt [16] sandhāraṇādabubhukṣasya [17]cātipragāḍhamudapānāt saṅkṣōbhaṇādvā śarīrasya ślēṣmā saha mārutēna prakōpamāpadyatē||10||
tairēva tu karśanaiḥ karśitasyātyaśanādatisnigdhagurumadhuraśītāśanātpiṣṭēkṣukṣīratilamāṣaguḍavikr̥tisēvanānmandakamadyātipānāddharitakātipraṇanayādānūpaudakagrāmyamāṁsātibhak<br>ṣaṇāt [16] sandhāraṇādabubhukṣasya [17]cātipragāḍhamudapānāt saṅkṣōbhaṇādvā śarīrasya ślēṣmā saha mārutēna prakōpamāpadyatē||10||
Taireva tu karshanaiH karshitasyAtyashanAdatisnigdhagurumadhurashItAshanAt
Taireva tu karshanaiH karshitasyAtyashanAdatisnigdhagurumadhurashItAshanAt
piShTekShukShIratilamAShaguDavikRutisevanAnmandakamadyAtipAnAddharitakAtipraNanayAdAnUpaudakagrAmyamAMsAtibhakShaNAt sandhAraNAdabubhukShasya cAtipragADhamudapAnAt sa~gkShobhaNAdvA sharIrasya shleShmA saha mArutena
piShTekShukShIratilamAShaguDavikRutisevanAnmandakamadyAtipAnAddharitakAtipraNanayAdAnUpaudakagrAmyamAMsAtibhakShaNAt sandhAraNAdabubhukShasya cAtipragADhamudapAnAt sa~gkShobhaNAdvA sharIrasya shleShmA saha mArutena
prakopamApadyate||10||
prakopamApadyate||10||
</div></div>
If a person weakened by diseases or aforesaid factors (in verse 6) takes too much unctuous, heavy, sweet and cold things, habitually takes preparations of (rice) flour, sugarcane, milk, sesame, black gram and coarse, unrefined sugar (jaggery), uses excessively immature curd, alcoholic drinks, salads, eats meat of marshy, aquatic and domesticated animals in excessive quantities, suppresses natural urges, drinks too much water when hungry, or is subjected to excessive shaking of the body (caused by travelling on rough roads, etc.), his ''kapha'' along with ''vata'' gets vitiated or aggravated. [10]
<div style="text-align:justify;">
If a person weakened by diseases or aforesaid factors (in verse 6) takes too much unctuous, heavy, sweet and cold things, habitually takes preparations of (rice) flour, sugarcane, milk, sesame, black gram and coarse, unrefined sugar (jaggery), uses excessively immature curd, alcoholic drinks, salads, eats meat of marshy, aquatic and domesticated animals in excessive quantities, suppresses natural urges, drinks too much water when hungry, or is subjected to excessive shaking of the body (caused by travelling on rough roads, etc.), his ''[[kapha]]'' along with ''[[vata]]'' gets vitiated or aggravated. [10]
</div>
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तं प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति
तं प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति
य उक्ता वातगुल्मे; श्लेष्मा त्वस्य शीतज्वरारोचकाविपाकाङ्गमर्द हर्षहृद्रोगच्छर्दिनिद्रालस्यस्तैमित्यगौरवशिरोभितापानुपजनयति, अपि च गुल्मस्यस्थैर्यगौरवकाठिन्यावगाढसुप्तताः, तथाकासश्वासप्रतिश्यायान् राजयक्ष्माणं चातिप्रवृद्धः, श्वैत्यं त्वङ्नखनयनवदनमूत्रपुरीषेषूपजनयति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत इति श्लेष्मगुल्मः||११||
य उक्ता वातगुल्मे; श्लेष्मा त्वस्य शीतज्वरारोचकाविपाकाङ्गमर्द हर्षहृद्रोगच्छर्दिनिद्रालस्यस्तैमित्यगौरवशिरोभितापानुपजनयति, अपि च गुल्मस्यस्थैर्यगौरवकाठिन्यावगाढसुप्तताः, तथाकासश्वासप्रतिश्यायान् राजयक्ष्माणं चातिप्रवृद्धः, श्वैत्यं त्वङ्नखनयनवदनमूत्रपुरीषेषूपजनयति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत इति श्लेष्मगुल्मः||११||
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taṁ prakupitaṁ māruta āmāśayaikadēśē saṁvartya [18] tānēva vēdanāprakārānupajanayati ya uktā vātagulmē; ślēṣmā tvasyaśītajvarārōcakāvipākāṅgamardaharṣahr̥drōgacchardinidrālasyastaimityagauravaśirōbhitāpānupajanayati, api ca gulmasyasthairyagauravakāṭhinyāvagāḍhasuptatāḥ, tathā kāsaśvāsapratiśyāyān rājayakṣmāṇaṁ cātipravr̥ddhaḥ, śvaityaṁtvaṅnakhanayanavadanamūtrapurīṣēṣūpajanayati, nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti ślēṣmagulmaḥ||11||
taṁ prakupitaṁ māruta āmāśayaikadēśē saṁvartya [18] tānēva vēdanāprakārānupajanayati ya uktā vātagulmē; ślēṣmā tvasyaśītajvarārōcakāvipākāṅgamardaharṣahr̥drōgacchardinidrālasyastaimityagauravaśirōbhitāpānupajanayati, api ca gulmasyasthairyagauravakāṭhinyāvagāḍhasuptatāḥ, tathā kāsaśvāsapratiśyāyān rājayakṣmāṇaṁ cātipravr̥ddhaḥ, śvaityaṁtvaṅnakhanayanavadanamūtrapurīṣēṣūpajanayati, nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti ślēṣmagulmaḥ||11||
tva~gnakhanayanavadanamUtrapurISheShUpajanayati, nidAnoktAni cAsya nopasherate,
tva~gnakhanayanavadanamUtrapurISheShUpajanayati, nidAnoktAni cAsya nopasherate,
viparItAni copasherata iti shleShmagulmaH||11||
viparItAni copasherata iti shleShmagulmaH||11||
</div></div>
Such aggravated ''vata'' along with vitiated ''kapha'', when accumulated in the ''amashaya'' (upper part of abdomen) region or a part of it, causes the same types of painful symptoms as mentioned for ''vata gulma''. ''Kapha'' causes fever accompanied with cold sensation, anorexia, indigestion, bodyache, horripilation, heart disease, vomiting, excess sleep, lassitude, sweating, and a feeling of heaviness and distress in the head. In the region where the ''gulma'' is located, there is fixity, heaviness, hardness, and numbness. Complications could occur such as cough, dyspnoea, coryza and even tuberculosis in much advanced stages. In terms of physical appearance, the patient develops whiteness in skin, nails, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. This variant of ''gulma'' is called ''kapha gulma''. [11]
<div style="text-align:justify;">
Such aggravated ''[[vata]]'' along with vitiated ''[[kapha]]'', when accumulated in the ''amashaya'' (upper part of abdomen) region or a part of it, causes the same types of painful symptoms as mentioned for ''[[vata]] gulma''. ''[[Kapha]]'' causes fever accompanied with cold sensation, anorexia, indigestion, bodyache, horripilation, heart disease, vomiting, excess sleep, lassitude, sweating, and a feeling of heaviness and distress in the head. In the region where the ''gulma'' is located, there is fixity, heaviness, hardness, and numbness. Complications could occur such as cough, dyspnoea, coryza and even tuberculosis in much advanced stages. In terms of physical appearance, the patient develops whiteness in skin, nails, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. This variant of ''gulma'' is called ''[[kapha]] gulma''. [11]
</div>
=== ''Tridosha'' dominant ''gulma'' ===
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त्रिदोषहेतुलिङ्गसन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति कुशलाः|
त्रिदोषहेतुलिङ्गसन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति कुशलाः|
स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचयगुल्मः||१२||
स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचयगुल्मः||१२||
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tridōṣahētuliṅgasannipātē tu sānnipātikaṁ gulmamupadiśanti kuśalāḥ|
tridōṣahētuliṅgasannipātē tu sānnipātikaṁ gulmamupadiśanti kuśalāḥ|
Tu sAnnipAtikaM gulmamupadishanti kushalAH| sa vipratiShiddhopakramatvAdasAdhyo
Tu sAnnipAtikaM gulmamupadishanti kushalAH| sa vipratiShiddhopakramatvAdasAdhyo
nicayagulmaH||12||
nicayagulmaH||12||
</div></div>
When the symptoms of three ''doshas'' are exhibited, a ''gulma'' patient is said to be ailing from ''sannipatika gulma''. This condition is incurable. [12]
When the symptoms of three ''[[dosha]]s'' are exhibited, a ''gulma'' patient is said to be ailing from ''sannipatika gulma''. This condition is incurable. [12]
=== ''Shonita gulma'' ===
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शोणितगुल्मस्तु खलु स्त्रिया एव भवति न पुरुषस्य, गर्भकोष्ठार्तवागमन वैशेष्यात्| पारतन्त्र्यादवैशारद्यात् सततमुपचारानुरोधाद्वा
शोणितगुल्मस्तु खलु स्त्रिया एव भवति न पुरुषस्य, गर्भकोष्ठार्तवागमन वैशेष्यात्| पारतन्त्र्यादवैशारद्यात् सततमुपचारानुरोधाद्वा
वेगानुदीर्णानुपरुन्धत्या आमगर्भे वाऽप्यचिरपतितेऽथवाऽप्यचिरप्रजाताया ऋतौ वा वातप्रकोपणान्यासेवमानायाः क्षिप्रंवातः प्रकोपमापद्यते||१३||
वेगानुदीर्णानुपरुन्धत्या आमगर्भे वाऽप्यचिरपतितेऽथवाऽप्यचिरप्रजाताया ऋतौ वा वातप्रकोपणान्यासेवमानायाः क्षिप्रंवातः प्रकोपमापद्यते||१३||
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śōṇitagulmastu khalu striyā ēva bhavati na puruṣasya, garbhakōṣṭhārtavāgamanavaiśēṣyāt|
śōṇitagulmastu khalu striyā ēva bhavati na puruṣasya, garbhakōṣṭhārtavāgamanavaiśēṣyāt|
Amagarbhe vA~apyacirapatite~athavA~apyaciraprajAtAyA Rutau vA
Amagarbhe vA~apyacirapatite~athavA~apyaciraprajAtAyA Rutau vA
VataprakopaNAnyAsevamAnAyAH kShipraM VataH prakopamApadyate||13||
VataprakopaNAnyAsevamAnAyAH kShipraM VataH prakopamApadyate||13||
</div></div>
''Shonita'' or ''raktagulma'' occurs specifically only in women and not in men because of presence of uterus and menstrual flow in the former. In woman, who suppress their natural urges because of dependence, ignorance or a constant attendance to service of others or uses ''vata'' aggravating substances soon after abortion, delivery or during menstruation, ''vata'' gets vitiated or aggravated quickly. [13]
<div style="text-align:justify;">
''Shonita'' or ''raktagulma'' occurs specifically only in women and not in men because of presence of uterus and menstrual flow in the former. In woman, who suppress their natural urges because of dependence, ignorance or a constant attendance to service of others or uses ''[[vata]]'' aggravating substances soon after abortion, delivery or during menstruation, ''[[vata]]'' gets vitiated or aggravated quickly. [13]
</div>
<div class="mw-collapsible mw-collapsed">
स प्रकुपितो योनिमुखमनुप्रविश्यार्तवमुपरुणद्धि, मासि मासि तदार्तवमुपरुध्यमानं |कुक्षिमभिवर्धयति|
स प्रकुपितो योनिमुखमनुप्रविश्यार्तवमुपरुणद्धि, मासि मासि तदार्तवमुपरुध्यमानं |कुक्षिमभिवर्धयति|
योन्याश्चाटालत्वम्, अपि च योन्या दौर्गन्ध्यमास्रावश्चोपजायते,
योन्याश्चाटालत्वम्, अपि च योन्या दौर्गन्ध्यमास्रावश्चोपजायते,
केवलश्चास्या गुल्मः पिण्डित एव स्पन्दते, तामगर्भां गर्भिणीमित्याहुर्मूढाः||१४||
केवलश्चास्या गुल्मः पिण्डित एव स्पन्दते, तामगर्भां गर्भिणीमित्याहुर्मूढाः||१४||
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sa prakupitō yōnimukhamanupraviśyārtavamuparuṇaddhi, māsi māsi tadārtavamuparudhyamānaṁ kukṣimabhivardhayati|
sa prakupitō yōnimukhamanupraviśyārtavamuparuṇaddhi, māsi māsi tadārtavamuparudhyamānaṁ kukṣimabhivardhayati|
api ca yonyA daurgandhyamAsrAvashcopajAyate, kevalashcAsyA
api ca yonyA daurgandhyamAsrAvashcopajAyate, kevalashcAsyA
gulmaH piNDita eva spandate, tAmagarbhAM garbhiNImityAhurmo UDhAH||14||
gulmaH piNDita eva spandate, tAmagarbhAM garbhiNImityAhurmo UDhAH||14||
</div></div>
This vitiated ''vata'' gets into the cervico-vaginal canal and checks the menstrual flow. If this continues for a prolonged period, the menstrual blood being obstructed accumulates and enlarges the abdomen. The patient consequently suffers from pain, cough, diarrhea, vomiting, anorexia, indigestion, bodyache, excess sleep, lassitude, dampness, and excessive salivation. There occurs appearance of milk in breasts, dark coloration of lips and areolar region, excessive heaviness in eyes, fainting, nausea, longing for certain food articles as seen during pregnancy, swelling in feet, dilatation of the vaginal orifice and foul smelling discharge from the vagina. There is pulsation in the entire mass of ''gulma'', confusing the patient (or her attendants) into thinking that she is pregnant. [14]
<div style="text-align:justify;">
This vitiated ''[[vata]]'' gets into the cervico-vaginal canal and checks the menstrual flow. If this continues for a prolonged period, the menstrual blood being obstructed accumulates and enlarges the abdomen. The patient consequently suffers from pain, cough, diarrhea, vomiting, anorexia, indigestion, bodyache, excess sleep, lassitude, dampness, and excessive salivation. There occurs appearance of milk in breasts, dark coloration of lips and areolar region, excessive heaviness in eyes, fainting, nausea, longing for certain food articles as seen during pregnancy, swelling in feet, dilatation of the vaginal orifice and foul smelling discharge from the vagina. There is pulsation in the entire mass of ''gulma'', confusing the patient (or her attendants) into thinking that she is pregnant. [14]
</div>
=== Prodormal symptoms ===
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एषां तु खलु पञ्चानां गुल्मानां प्रागभिनिर्वृत्तेरिमानि
एषां तु खलु पञ्चानां गुल्मानां प्रागभिनिर्वृत्तेरिमानि
अग्निवैषम्यं, विदाहो भुक्तस्य, पाककाले चायुक्त्या छर्द्युद्गारौ, वातमूत्रपुरीषवेगानां चाप्रादुर्भावः, प्रादुर्भूतानां चाप्रवृत्तिरीषदागमनं वा, वातशूलाटोपान्त्रकूजनापरिहर्षणातिवृत्तपुरीषताः,
अग्निवैषम्यं, विदाहो भुक्तस्य, पाककाले चायुक्त्या छर्द्युद्गारौ, वातमूत्रपुरीषवेगानां चाप्रादुर्भावः, प्रादुर्भूतानां चाप्रवृत्तिरीषदागमनं वा, वातशूलाटोपान्त्रकूजनापरिहर्षणातिवृत्तपुरीषताः,
अबुभुक्षा, दौर्बल्यं,सौहित्यस्य चासहत्वमिति||१५||
अबुभुक्षा, दौर्बल्यं,सौहित्यस्य चासहत्वमिति||१५||
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ēṣāṁ tu khalu pañcānāṁ gulmānāṁ prāgabhinirvr̥ttērimāni pūrvarūpāṇi bhavanti; tadyathā- anannābhilaṣaṇam, arōcakāvipākau, agnivaiṣamyaṁ, vidāhō bhuktasya,pākakālē cāyuktyā chardyudgārau, vātamūtrapurīṣavēgānāṁ cāprādurbhāvaḥ, prādurbhūtānāṁ cāpravr̥ttirīṣadāgamanaṁ vā,vātaśūlāṭōpāntrakūjanāpariharṣaṇātivr̥ttapurīṣatāḥ, abubhukṣā, daurbalyaṁ, sauhityasya cāsahatvamiti||15||
ēṣāṁ tu khalu pañcānāṁ gulmānāṁ prāgabhinirvr̥ttērimāni pūrvarūpāṇi bhavanti; tadyathā- anannābhilaṣaṇam, arōcakāvipākau, agnivaiṣamyaṁ, vidāhō bhuktasya,pākakālē cāyuktyā chardyudgārau, vātamūtrapurīṣavēgānāṁ cāprādurbhāvaḥ, prādurbhūtānāṁ cāpravr̥ttirīṣadāgamanaṁ vā,vātaśūlāṭōpāntrakūjanāpariharṣaṇātivr̥ttapurīṣatāḥ, abubhukṣā, daurbalyaṁ, sauhityasya cāsahatvamiti||15||
VatashUlATopAntrakUjanApariharShaNAtivRuttapurIShatAH,
VatashUlATopAntrakUjanApariharShaNAtivRuttapurIShatAH,
abubhukShA, daurbalyaM, sauhityasya cAsahatvamiti||15||
abubhukShA, daurbalyaM, sauhityasya cAsahatvamiti||15||
</div></div>
These five types of ''gulma'' have the following prodormal symptoms just prior to occurring: aversion to food, anorexia and indigestion, disturbed metabolism, burning sensation after taking meals, vomiting and unusual eructations, reduced urge for flatus, urine and bowel movements, pain, distension, gurgling sound, horripilation and diarrhea due to ''vata'', loss of appetite, debility, and inability to endure satiety. [15]
<div style="text-align:justify;">
These five types of ''gulma'' have the following prodormal symptoms just prior to occurring: aversion to food, anorexia and indigestion, disturbed metabolism, burning sensation after taking meals, vomiting and unusual eructations, reduced urge for flatus, urine and bowel movements, pain, distension, gurgling sound, horripilation and diarrhea due to ''[[vata]]'', loss of appetite, debility, and inability to endure satiety. [15]
</div>
=== Prognosis and general principles of management ===
<div class="mw-collapsible mw-collapsed">
सर्वेष्वपि खल्वेतेषु गुल्मेषु न कश्चिद्वातादृते सम्भवति गुल्मः|
सर्वेष्वपि खल्वेतेषु गुल्मेषु न कश्चिद्वातादृते सम्भवति गुल्मः|
वातचिकित्सितं प्रणयेत्, स्नेहस्वेदौ वातहरौ स्नेहोपसंहितं च मृदु विरेचनं बस्तींश्च; अम्ललवणमधुरांश्च रसान् युक्त्याऽवचारयेत्|
वातचिकित्सितं प्रणयेत्, स्नेहस्वेदौ वातहरौ स्नेहोपसंहितं च मृदु विरेचनं बस्तींश्च; अम्ललवणमधुरांश्च रसान् युक्त्याऽवचारयेत्|
मारुते ह्युपशान्ते स्वल्पेनापि प्रयत्नेन शक्योऽन्योऽपि दोषो नियन्तुं गुल्मेष्विति||१६||
मारुते ह्युपशान्ते स्वल्पेनापि प्रयत्नेन शक्योऽन्योऽपि दोषो नियन्तुं गुल्मेष्विति||१६||
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sarvēṣvapi khalvētēṣu gulmēṣu na kaścidvātādr̥tē sambhavati gulmaḥ|
sarvēṣvapi khalvētēṣu gulmēṣu na kaścidvātādr̥tē sambhavati gulmaḥ|
gurUnupadravAMstvaramANashcikitsejjaghanyamitarAn|
gurUnupadravAMstvaramANashcikitsejjaghanyamitarAn|
tvaramANastu visheShamanupalabhamAno gulmeShvAtyayike karmaNi VatacikitsitaM praNayet, snehasvedau Vataharau snehopasaMhitaM ca mRudu virecanaM bastIMshca; amlalavaNamadhurAMshca rasAn yuktyA~avacArayet| mArute hyupashAnte svalpenApi prayatnena shakyo~anyo~api doSho niyantuM gulmeShviti||16||
tvaramANastu visheShamanupalabhamAno gulmeShvAtyayike karmaNi VatacikitsitaM praNayet, snehasvedau Vataharau snehopasaMhitaM ca mRudu virecanaM bastIMshca; amlalavaNamadhurAMshca rasAn yuktyA~avacArayet| mArute hyupashAnte svalpenApi prayatnena shakyo~anyo~api doSho niyantuM gulmeShviti||16||
</div></div>
As is evident from the descriptions of ''gulma'', no variant is caused without vitiation of ''vata''. Amongst these variants, ''sannipatika'' ''gulma'' is incurable and should not be treated. The variant caused by just one ''dosha'', should be treated with suitable therapeutics prescribed for respective ''dosha''. Those caused by a combination of two ''doshas'' (''vata – pitta'' or ''vata – kapha'') should be managed with the general therapeutic measures applicable to ''dwidoshic'' ailments. The measures that are not contrary to the ''dosha'' can be applied according to severity of complications. In case of emergency situations, the measures applicable in treatment of ''vata gulma'', such as ''vata''-alleviating unction, fomentation, mild unctuous purgation, enema, and use of sweet, sour and salty substances should be administered. If ''vata'' is pacified, then the disease can be cured even with little efforts and other types of ''gulma'' can also be treated. [16]
<div style="text-align:justify;">
As is evident from the descriptions of ''gulma'', no variant is caused without vitiation of ''[[vata]]''. Amongst these variants, ''sannipatika'' ''gulma'' is incurable and should not be treated. The variant caused by just one ''[[dosha]]'', should be treated with suitable therapeutics prescribed for respective ''[[dosha]]''. Those caused by a combination of two ''[[dosha]]s'' (''[[vata]] – [[pitta]]'' or ''[[vata]] – [[kapha]]'') should be managed with the general therapeutic measures applicable to ''dwidoshic'' ailments. The measures that are not contrary to the ''[[dosha]]'' can be applied according to severity of complications. In case of emergency situations, the measures applicable in treatment of ''[[vata]] gulma'', such as ''[[vata]]''-alleviating unction, fomentation, mild unctuous purgation, enema, and use of sweet, sour and salty substances should be administered. If ''[[vata]]'' is pacified, then the disease can be cured even with little efforts and other types of ''gulma'' can also be treated. [16]
</div>
<div class="mw-collapsible mw-collapsed">
भवति चात्र-
भवति चात्र-
गुल्मिनामनिलशान्तिरुपायैः सर्वशो विधिवदाचरितव्या|
गुल्मिनामनिलशान्तिरुपायैः सर्वशो विधिवदाचरितव्या|
मारुते ह्यवजितेऽन्यमुदीर्णं दोषमल्पमपि कर्म निहन्यात्||१७||
मारुते ह्यवजितेऽन्यमुदीर्णं दोषमल्पमपि कर्म निहन्यात्||१७||
<div class="mw-collapsible-content">
bhavati cātra- gulmināmanilaśāntirupāyaiḥ sarvaśō vidhivadācaritavyā|
bhavati cātra- gulmināmanilaśāntirupāyaiḥ sarvaśō vidhivadācaritavyā|
gulminAmanilashAntirupAyaiH sarvasho vidhivadAcaritavyA| mArute
gulminAmanilashAntirupAyaiH sarvasho vidhivadAcaritavyA| mArute
hyavajite~anyamudIrNaM doShamalpamapi karma nihanyAt||17||
hyavajite~anyamudIrNaM doShamalpamapi karma nihanyAt||17||
</div></div>
In the case of ''gulma'', all the measures for pacification of ''vata'' should be administered properly because after ''vayu'' is controlled over, other aggravated ''doshas'' can be alleviated even with small remedies. [17]
In the case of ''gulma'', all the measures for pacification of ''[[vata]]'' should be administered properly because after ''vayu'' is controlled over, other aggravated ''[[dosha]]s'' can be alleviated even with small remedies. [17]
=== Summary ===
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तत्र श्लोकः-
तत्र श्लोकः-
सङ्ख्या निमित्तं रूपाणि पूर्वरूपमथापि च|
सङ्ख्या निमित्तं रूपाणि पूर्वरूपमथापि च|
दिष्टं निदाने गुल्मानामेकदेशश्च कर्मणाम्||१८||
दिष्टं निदाने गुल्मानामेकदेशश्च कर्मणाम्||१८||
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tatra ślōkaḥ- saṅkhyā nimittaṁ rūpāṇi pūrvarūpamathāpi ca|
tatra ślōkaḥ- saṅkhyā nimittaṁ rūpāṇi pūrvarūpamathāpi ca|
sa~gkhyA nimittaM rUpANi pUrvarUpamathApi ca| diShTaM
sa~gkhyA nimittaM rUpANi pUrvarUpamathApi ca| diShTaM
nidAne gulmanAmekadeshashca karmaNAm||18||
nidAne gulmanAmekadeshashca karmaNAm||18||
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Now, to summarize:
Now, to summarize:
In the chapter on diagnosis of ''gulma'' the number, causative factor, symptoms and prodromal symptoms along with a portion of treatment of ''gulmas'' have been described.[18]
In the chapter on diagnosis of ''gulma'' the number, causative factor, symptoms and prodromal symptoms along with a portion of treatment of ''gulmas'' have been described.[18]
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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने गुल्मनिदानं
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने गुल्मनिदानं
नाम तृतीयोऽध्यायः||३||
नाम तृतीयोऽध्यायः||३||
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ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē gulmanidānaṁ nāma tr̥tīyō'dhyāyaḥ||3||
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē gulmanidānaṁ nāma tr̥tīyō'dhyāyaḥ||3||
ityagniveshakRute tantre tantre carakapratisaMskRute nidAnasthAne gulmanidAnaM nAma tRutIyo~adhyAyaH||3||
ityagniveshakRute tantre tantre carakapratisaMskRute nidAnasthAne gulmanidAnaM nAma tRutIyo~adhyAyaH||3||
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Thus ends the third chapter on the diagnosis of ''gulma'' in the treatise composed by Agnivesha and redacted by Charaka.
Thus ends the third chapter on the diagnosis of ''gulma'' in the treatise composed by Agnivesha and redacted by Charak.
=== ''Tattva Vimarsha'' ===
== Tattva Vimarsha (Fundamental Principles) ==
<div style="text-align:justify;">
*''Gulma'' is a disease of the ''mahastrotas'' (gastro-intestinal tract/abdomen) and is caused due to predominance of ''[[vata]]''. It is of five types depending upon its location (limited to the gastro-intestinal region between the heart and the bladder). Four types of ''gulma'' are common to both males and females while the fifth, ''raktaja gulma'', is a condition limited to females.
*''Gulmas'' also vary by the vitiation of other [[dosha]]s besides ''[[vata]]''. The ''sannipitaka gulma'', caused by vitiation of all three ''[[dosha]]s'', is said to be incurable.
*A primary feature of ''gulma'' is obstruction to the path of ''[[vata]]'', which can be due to causes like tumor, stricture, inflammation, tuberculosis, parasites, etc.
*''Gulma'' with acute symptoms should have urgent relief of ''[[vata]]'' obstruction.
*Treatment of ''[[vata]] gulma'' includes ''[[vata]]''-alleviating unction, fomentation, mild unctuous purgation, enema, and use of sweet, sour and salty substances. If ''[[vata dosha]]'' is pacified in ''gulma'' disease, then other two ''[[dosha]]'' can also be controlled.
== Vidhi Vimarsha (Applied Inferences) ==
A comprehensive effort has been made in [[Ayurveda]] to describe different types of swellings occurring in the body e.g. ''gulma, udara roga, vriddhi roga, granthi, arbuddha, shopha,'' and ''vidradhi'', etc. They can be distinguished from each other according to their specific characteristics as written in different classics of [[Ayurveda]]. Generalized abdominal swellings have been described under the heading of ''udara roga'' (abdominal diseases including ascitis), while localized, non-suppurated swellings are ''gulmas''. Other localized swellings, such as ''vriddhi roga'' (hernia and hydrocele), have also been described by ancient authors but such swellings are in regions other than the gastro-intestinal region, or in parts of the body such as the scrotal and inguinoscrotal region.
''Shopha'' is a localized inflammatory swelling. ''Vidradhi'' (abscess) are also localized but large suppurative lesions and are deep - rooted that may develop either from external surfaces or internal body cavities. ''Granthi'' (cyst) and ''arbuda'' (tumor) are also localized, progressively increasing knotty lesions and are primarily non suppurative in nature. Such swellings may arise in any part of the body and are commonly known as neoplastic lesions.
=== Etiopathogenesis of ''gulma'' ===
In [[Charaka Samhita]], vitiated ''vata dosha'' is considered as major aetiological factor for the development of any type of ''gulma''. Amongst the five types of ''vata'' mentioned in [[Charaka Samhita]], vitiated ''apana'' and/or ''samana vata'' seem to be the primary etiological factors of ''gulma'', since these are mainly responsible for the normal physiological functions of ''mahastrotas''. The prodromal symptoms of ''gulma'' also point towards these two e.g. aversion to food, anorexia, and diminished urge to pass flatus, urine and feces.
In [[Charak Samhita]], vitiated ''[[vata dosha]]'' is considered as major etiological factor for the development of any type of ''gulma''.[Cha.Sa.[[Chikitsa Sthana]] 28/58] Among the five types of ''[[vata]]'' mentioned in [[Charak Samhita]], vitiated ''apana'' and/or ''samana [[vata]]'' seem to be the primary etiological factors of ''gulma'', since these are mainly responsible for the normal physiological functions of ''mahastrotas''. The prodromal symptoms of ''gulma'' also point towards these two e.g. aversion to food, anorexia, and diminished urge to pass flatus, urine and feces.
In [[Chikitsa Sthana]], Charaka states that ''vata'' gets vitiated by two basic means i.e. ''dhatukshaya'' (tissue wasting) and ''margavarana'' (obstruction). The etiology given in this chapter could also include excess consumption of food with ''ruksha guna'', trauma and faulty ''shodhana'' procedures, excessive loss of ''mala'' and ''dhatu'' responsible for ''dhatukshaya'' and various other factors that vitiate ''doshas'' and ''mala'' causing obstruction of different channels, further aggravating ''vata''.
In [[Chikitsa Sthana]], Charak states that ''[[vata]]'' gets vitiated by two basic means i.e. ''dhatukshaya'' (tissue wasting) and ''margavarana'' (obstruction). The etiology given in this chapter could also include excess consumption of food with ''ruksha [[guna]]'', trauma and faulty ''[[shodhana]]'' procedures, excessive loss of ''[[mala]]'' and ''[[dhatu]]'' responsible for ''dhatukshaya'' and various other factors that vitiate ''[[dosha]]s'' and ''[[mala]]'' causing obstruction of different channels, further aggravating ''[[vata]]''.
While analyzing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''doshas'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''doshas'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear. Also, in the absence of any ''dushya'' (''dhatu'' and ''mala''), these swellings are commonly non-suppurative in nature. There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charaka has mentioned that suppuration may takes place in ''pittaja'' ''gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), pachyamana (intermediary stage) and pakwa awastha (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''pitta gulma'' is not treated timely, ''pitta dosha'' and ''rakta dhatu'' get aggravated (together or separately), and involves the deeper structure (''kritmulam'').
While analysing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''[[dosha]]s'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''[[dosha]]''(s), together with ''[[dushya]]'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''[[dosha]]'' and ''[[dushya]]'' is critical. However for ''gulma'', only vitiated ''[[dosha]]s'' are responsible and there is no involvement of ''[[dushya]]''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear.
Also, in the absence of any ''[[dushya]]'' (''[[dhatu]]'' and ''[[mala]]''), these swellings are commonly non-suppurative in nature.<ref>Sushruta. Uttara Tantra, Cha.42 Gulmapratisheda Adhyaya verse 6. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charak has mentioned that suppuration may takes place in ''pittaja gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), ''pachyamana'' (intermediary stage) and ''pakwa awastha'' (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''[[pitta]] gulma'' is not treated timely, ''[[pitta dosha]]'' and ''[[rakta dhatu]]'' get aggravated (together or separately), and involves the deeper structure (''kritmulam'').
==== Location of ''gulma'' ====
=== ''Shadkriyakala'' (lifecycle) of ''Gulma'' ===
#''Sanchaya-[[Vata]]'' accumulates in ''vatasthana'' (''pakwashaya'', or the intestines) with the consumption of ''vatika'' food and activities such as excessive exercise, suppressing emergent urges etc., further aggravating it.
#''Prakopa''- Consumption of ''ruksha, khara'' and ''sheeta'' food for prolonged periods of time reduces the ''snigdha'' quality of '''strotas''' while stimulating excess ''[[vata]]'' to overflow from its ''sthana''.
#''Prasara''-In this stage aggravated ''[[vata]]'' dislodges from its accumulated site and spreads all over the body.
#''Sthanasanshraya''- This is the stage in which the ''[[dosha]]'' stays at a particular locus and comes in contact with ''[[dushya]]''. In case of ''gulma'', the ''mahastrotas'' are the principal loci, with an absence of ''[[dushya]]'' in their formation. The vitiated ''[[vata]]'' and other ''[[dosha]]s'' have an affinity towards specific loci such as ''hridaya, nabhi, basti'' etc. to get lodged there. Prodromal symptoms of ''gulma'' such as anorexia, aversion for food, weakness etc. also become apparent at this stage.
#''Vyakti''- Clinical features of different types of ''gulma'' manifest at this stage so management can be done depending upon specific ''[[dosha]]'' characteristics.
#''Bheda''-When the ''gulma'' is not treated at the fourth and fifth stage, complications like ''bradhna roga'' (inguinal swelling), ''[[jwara]]'' (fever), ''vidbheda'' (loose stools/diarrhea), and suppuration (in case of ''pittaja gulma'') occur where surgical intervention could be necessary.
=== Location of ''gulma'' ===
With respect to the ''adhishthana'' (location) of ''gulma'', five major sites have been mentioned [Cha.Sa. [[Chikitsa Sthana]] 5/8], including the ''hridaya, nabhi, basti,'' and ''parshwadwaya'' (flanks). In the context of this chapter, ''hridaya'' should be taken as the upper part of the abdominal cavity rather than the thoracic cage as described in [[Sharira Sthana]]. ''[[Vata]] gulma'' most commonly occurs in ''basti'', while ''[[pitta]] gulma'' occurs most commonly in the ''nabhi'' region, and ''[[kapha]] gulma'' in the ''hridaya'' and ''parshwadwaya'' regions.<ref>Vagbhata. Sutra Sthana, Cha.11 Vidradivriddhigulmanidana verse 41. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. </ref> The ''yakrita gulma'' occurs in the region of ''hridaya, ashtheela gulma'' in the region of ''kukshi'' (hypogastrium), ''pleeha gulma'' in the ''madhya'' (central) region, ''chandravivardhaka gulma'' in the region of ''basti'' , and ''granthi gulma'' afflicts the region of ''nabhi''.<ref>Harita, Harita Samhita. Tritiya Sthana, Chap 4, Gulma Chikista, Verse 2-4, In: Harihariprasad Tripati, Editor. Harita Samhita. 2nd ed. Varanasi: Chaukhambha Krishnadas Academy; 2009</ref>
The pathogenesis of ''pittaja'' and ''kaphaja gulma'' takes place in ''amashaya'' that lies in the region between ''hridaya'' and ''basti'' [Chakrapani on Cha.Sa.[[Nidana Sthana]] 03]. Thus these two variants of ''gulma'' (i.e., ''pittaja'' and ''kaphaja'') cannot occur in ''basti''. The five sites of ''gulma'' can be mapped to the following anatomical sites of the abdomen:
{|class = "wikitable"
|-
!scope = "col"| Types of ''gulma''
!scope = "col"| ''Adhisthana''
!scope = "col"| Anatomical site
!scope = "col"| ''Charak''
!scope = "col"| ''Sushruta''
!scope = "col"| ''Vagbhata''
!scope = "col"| ''Harita''
|-
|''Vataja''
|''Basti''
| Lower abdomen
| Does not specify
| Does not specify
| Same
| Not mentioned
|-
|''Pittaja''
|''Nabhi''
| Mid-abdomen
| Does not specify
| Does not specify
| Same
| Not mentioned
|-
|rowspan="2"|''Kaphaja''
|''Hridaya''
| Upper-abdomen
|rowspan="2"|Does not specify
|rowspan="2"|Does not specify
|rowspan="2"|Same
|rowspan="2"|Not mentioned
|-
|''parshwadwaya''(''dakshina parshwa'' and ''vama parshwa'')
| right and left flank
|-
|''Shonitaja''
|''Garbhashaya'' and ''yoni''
| Uterus and vagina
| Same
| Same
| Same
| Not mentioned
|-
|''Sannipataja''
| Not specified
| Not specified
| Not specified
| Not specified
| Not specified
| Not mentioned
|-
|''Yakrita gulma''
|''Hridaya''
| Upper abdomen
| Not mentioned
| Not mentioned
| Not mentioned
| Same
|-
|''Ashtheela gulma''
|''Kukshi''
| Mid-abdomen
| Not mentioned
| Not mentioned
| Not mentioned
| Same
|-
|''Pleeha gulma''
|''Madhya bhaga''
| Mid-abdomen
| Not mentioned
| Not mentioned
| Not mentioned
| Same
|-
|''Chandravivardhaka gulma''
|''Basti''
| Lower-abdomen
| Not mentioned
| Not mentioned
| Not mentioned
| Same
|-
|''Granthi gulma''
|''Nabhi''
| Umbilical region
| Not mentioned
| Not mentioned
| Not mentioned
| Same
|-
|}
'''Prognosis''' –''Sannipatika gulma'' is incurable, rest four are curable when treated timely.
'''Management'''- All the four types of ''gulma'' can be managed according to the prevalent ''[[dosha]]s''. In emergency conditions if there is no time to diagnose the type of ''gulma, [[vata dosha]]'' should be managed first as it is prevalent in all types of ''gulma''.
''Vataja gulma'' are mostly irregular, transitory swellings. These are accompanied with different intensities of colicky pain. Complications like inguinal swelling (''bradhna roga'') gurgling sound in the intestines (''antrakoojana''), fever/elevated temperature in the evenings, splenomegaly (''pleehavriddhi''), difficulty in breathing, bodyache (''angamarda''), and headache are commonly in the advanced stages of ''gulma''. The above clinical features can be seen in chronic intestinal obstruction, intestinal tuberculosis, pyloric stenosis and in mobile caecum. Intestinal tuberculosis is a chronic condition with common symptoms including transitory nodules of varying sizes occurring due to partial intestinal obstruction, often accompanied with gurgling sounds from the abdomen, poor appetite, and evening fevers, as seen in the advanced stages of ''vatika gulma''. Mobile upper abdominal lump, with nausea and breathing difficulty are the features present in the case of pyloric stenosis. In mobile caecum there is also chronic progressive pain in the right flank and in the lower abdomen.
Considering the various clinical features of ''gulma'' it can be said that the majority of ''gulmas'' are non-inflammatory and non-malignant intra-abdominal swellings. But some ''gulmas'' show indications of inflammatory swellings, some benign while some show the characteristics of malignant growths.
=== ''Vataja gulma'' ===
''Vataja gulma'' are mostly irregular, transitory swellings. These are accompanied with different intensities of colicky pain.
Complications like inguinal swelling (''bradhna roga'') gurgling sound in the intestines (''antrakoojana''), fever/elevated temperature in the evenings, splenomegaly (''pleehavriddhi''), difficulty in breathing, bodyache (''angamarda''), and headache are commonly in the advanced stages of ''gulma''. The above clinical features can be seen in chronic intestinal obstruction, intestinal tuberculosis, pyloric stenosis and in mobile caecum. Intestinal tuberculosis is a chronic condition with common symptoms including transitory nodules of varying sizes occurring due to partial intestinal obstruction, often accompanied with gurgling sounds from the abdomen, poor appetite, and evening fevers, as seen in the advanced stages of ''vatika gulma''. Mobile upper abdominal lump, with nausea and breathing difficulty are the features present in the case of pyloric stenosis. In mobile caecum there is also chronic progressive pain in the right flank and in the lower abdomen.
=== ''Pittaja gulma'' ===
They are painful abdominal lumps characterized with fever, sweating, thirst, burning sensations and burning eructations. These features are suggestive of inflammatory and suppurative changes in the intra-abdominal lump. In due course of time, ''pittaja gulma'' develops yellow discoloration of nail, eyes and skin, fever, and vertigo as an added complication. These features can be seen in obstructive biliary tract.
=== ''Kaphaja gulma'' ===
These are fixed, solid abdominal lumps associated with heaviness, vomiting, mild pain and poor appetite. Further, if the exposure to etiological factors is continued, the patient may develop cough, breathing difficulty and ''rajayakshma'' (tuberculosis) etc. Such swellings can be compared with solid tumors of the abdomen which may or may not be associated with obstructive features of the gastrointestinal tract.
=== ''Sannipataja gulma'' ===
These swellings are progressively increasing in size, fixed, deep rooted, covered with prominent veins, bulged out, and associated with weakness, nausea, vomiting, fever and thirst. Such features can be seen in malignant abdominal tumors.
=== ''Raktaja gulma'' ===
These exhibit symptoms similar to those of pregnancy, so it is essential to differentiate them from the point of view of treatment:
==== Study of abdominal swellings ====
{|class = "wikitable"
|-
!scope = "col"|''Raktaja Gulma''
!scope = "col"|''Garbha'' (Pregnancy)
|-
| Slight movement may be present in later stage
| Some movement is present throughout all trimesters
|-
| Size increases progressively and it remains localized
| Progressive change in size
|-
| It may be associated with fever, cough, pain etc.
| Presence of other constitutional features of pregnancy, including bodily changes
|-
|}
The features of Hydatidiform mole and chronic carcinoma closely resemble the features of ''raktaja gulma''.
A study was conducted in 50 patients of abdominal swellings, ''gulmas'' were analysed using clinical tests and radio-imaging techniques such as plain X ray abdomen, Barium studies, USG, intra-operative findings and HPE of the lumps.<ref>Kumar Satish et al. 1986. Ultrasonographic and other radiological investigative studies on gulma in relation to malignancy. Thesis work submitted at Banaras Hindu University, Varanasi.</ref>
*The study showed that ''vataja gulma'' has chronic obstructive lesions associated with gastrointestinal tract as in the cases of intestinal tuberculosis, pyloric obstruction due to carcinoma of the stomach, etc.
*The study showed that ''vataja gulma'' has chronic obstructive lesions associated with gastrointestinal tract as in the cases of intestinal tuberculosis, pyloric obstruction due to carcinoma of the stomach, etc.
*''Pittaja gulma'' includes nonspecific inflammatory lesions such as cholecystitis presenting as mucocele or empyema of gall bladder, appendicitis , etc.
*''Pittaja gulma'' includes nonspecific inflammatory lesions such as cholecystitis presenting as mucocele or empyema of gall bladder, appendicitis , etc.
*''Raktaja gulma'' features are found in hydatidiform mole and chorio-carcinoma.
*''Raktaja gulma'' features are found in hydatidiform mole and chorio-carcinoma.
== Researches ==
Thesis work done- Ultrasonographic and other radiological investigative studies on gulma in relation to malignancy (Kumar Satish et al in 1986).
== Reference Books ==
*[[Charak Samhita]], translation by Acharya P. V. Sharma.
*[[Charak Samhita]], translation by Acharya Bhagvanadasa.
*Sushruta Samhita Uttaratantra 42.
*Ashtanga Hridaya Nidana Sthana 11.
*Ashtanga Samgraha -11(Vidradhi vridhi and gulma nidanam)
*Bhavaprakasha Madhyakhanda
*Madhavanidana- gulmanidana
== Related Chapters ==
* [[Gulma Chikitsa]]
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