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Gulma Chikitsa (view source)

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|titlemode=append

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

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|description=Chikitsa Sthana Chapter 5.Management of Gulma ~~(abdominal lump)~~

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|description=Chikitsa Sthana Chapter 5.Management of Gulma

}}

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<big>'''[[Chikitsa Sthana]] Chapter 5.Management of Gulma ~~(abdominal lump)~~'''</big>

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

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

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== Sanskrit text, Transliteration and English Translation ==

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==== Management of ''Gulma'' (abdominal lumps) ====

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=== Management of ''Gulma'' (abdominal lumps) ===

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</div></div>

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Now we ~~will~~ expound the chapter ~~entitled [[~~Gulma Chikitsa]] . Thus said Lord Atreya [1-2]

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Now we shall expound the chapter "Gulma Chikitsa" (Management of Gulma) . Thus said Lord Atreya. [1-2]

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Punarvasu the fatherly figure for all, who has knowledge of past and future, who is the best among the exponents, describes the treatment for the complete eradication of ''gulma'' [3]

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==== Etio-pathogenesis of ''gulma'' ====

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=== Etio-pathogenesis of ''gulma'' ===

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

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

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

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

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

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=== 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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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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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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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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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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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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Feeling as covered by wet cloth, fever with chills, exhaustion of limbs, nausea, cough, anorexia, heaviness, cold and mild pain with palpable hard and protruded mass are the signs and symptoms of ''kaphaja-gulma'' [15]

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==== ''Dvi-doshaja gulma'' ====

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=== ''Dvi-doshaja gulma'' ===

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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]

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

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

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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]

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

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

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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]

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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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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]

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

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

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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]

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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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''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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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]

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

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

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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]

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

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

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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]

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

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

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

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

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

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

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

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

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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]

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

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

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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]

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==== Diet after blood-letting ====

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=== Diet after blood-letting ===

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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]

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

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

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Immovable lump of ''gulma'' which is deeply situated under the flesh and hard and heavy to palpate and whose color remains unchanged is considered as ''apakva'' i.e. non-suppurative [40]

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==== Symptoms of suppurating (''vidahamana'') ''gulma'' ====

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=== Symptoms of suppurating (''vidahamana'') ''gulma'' ===

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The ''gulma'' with symptoms of burning sensation, much pain, very much irritation and discomfort, loss of sleep and fever indicates that it is about to suppurate. In this condition ''upanaha'' (poultice) is indicated. [41]

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==== Symptoms of suppurated ''gulma'' ====

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=== Symptoms of suppurated ''gulma'' ===

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The above mentioned symptoms also occur in suppurating (''pachyamana'') internal ''gulma''. Only difference is that in the internal ''gulma'' there is swelling in cardiac region of the abdomen while exterior ''gulma'' protrudes towards sides of abdomen [45]

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==== Management of pus discharging ''gulma'' ====

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=== Management of pus discharging ''gulma'' ===

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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]

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

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

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

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

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''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]

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===== Indications of vamana =====

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==== Indications of vamana ====

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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]

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

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

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Now the specific preparations for the cure of ''gulma'' will be described [64 ½]

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===== ''Tryushanadi-ghritam'' =====

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==== ''Tryushanadi-ghritam'' ====

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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]

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

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

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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]

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

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

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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]

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

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

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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]

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

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

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The drugs mentioned in the above ''ghrita'' preparations may also be used in form of powders, suppositories or decoctions for the treatment of ''gulma'' [76]

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==== ''Peya'' (liquid gruel) ====

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=== ''Peya'' (liquid gruel) ===

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Or prepare the suppositories and pills by impregnating the powders of the above drugs in the juice of pomelo (''matulunga'') and use them for providing relief in ''gulma'', distension of abdomen and discomfort [78]

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==== ''Hingvadi churna'' and ''gutika'' ====

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=== ''Hingvadi churna'' and ''gutika'' ===

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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]

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

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

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This pill cures ''gulma'', spleen disorders, distension of abdomen, dyspnea, anorexia, hiccup, heart diseases, piles, various types of headache, anemia, excessive of secretions (''kaphotklesha''), all types of dysenteries and pain in hypogastric, epigastric and hypochondric regions of the abdomen [86-90]

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==== ''Nagara'' preparation ====

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=== ''Nagara'' preparation ===

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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]

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

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

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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]

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

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

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The mixture of castor oil, ''prasanna'' wine, cow’s urine, ''aranala'' (sour ''kanji'') and ''yavakshara'' is known as ''tailapanchakam''. Its oral administration cures ''gulma'', gastric disorders and distension of abdomen [96]

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==== ''shilajatu-prayoga'' ====

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=== ''shilajatu-prayoga'' ===

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

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

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

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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]

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==== ''Swedana'' ====

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=== ''Swedana'' ===

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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]

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

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

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''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]

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==== Medicated oils ====

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=== Medicated oils ===

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

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

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

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

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

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

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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]

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

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

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

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==== Protection of ''agni'' ====

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=== Protection of ''agni'' ===

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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]

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==== Oleation therapy ====

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=== Oleation therapy ===

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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]

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

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

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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]

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==== ''Rohiṇyadya ghritam'' ====

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=== ''Rohiṇyadya ghritam'' ===

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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]

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==== ''Trayamaṇadi ghritam'' ====

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=== ''Trayamaṇadi ghritam'' ===

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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]

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

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

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Prepare ''ghrita'' with four parts of juice of ''amalaki'' and sugarcane juice, one-fourth part of paste of ''haritaki'' and one part of ghee. It is to be taken orally to cure pitta ''gulma''. Thus ''amalakadyam ghritam'' is described [122]

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==== ''Drakshadi ghritam'' ====

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=== ''Drakshadi ghritam'' ===

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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]

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==== ''Vasaghr̥itam'' ====

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=== ''Vasaghr̥itam'' ===

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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]

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==== Massage ====

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=== 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]

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

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

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''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]

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

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

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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]

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

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

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''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]

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

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

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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]

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

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

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===== ''Vamana'' in ''kaphaja gulma'' =====

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==== ''Vamana'' in ''kaphaja gulma'' ====

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

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

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

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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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==== Post-operative measures ====

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=== Post-operative measures ===

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After the above operation apply the paste made from sesame, castor seed, linseeds and mustard seeds on the ''gulma'' and do its sudation through bearable hot iron pot [141]

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==== ''Dashamuli ghrita'' ====

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=== ''Dashamuli ghrita'' ===

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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]

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

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

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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]

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==== ''Kshiraṣhaṭpalaka ghritam'' ====

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=== ''Kshiraṣhaṭpalaka ghritam'' ===

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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]

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

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

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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]

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

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

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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]

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

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

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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]

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

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

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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]

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==== Powders and pills ====

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=== Powders and pills ===

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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]

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

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

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''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]

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

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

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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]

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

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

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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 as incurable [169-170]

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==== Signs and symptoms of bad prognosis ====

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=== Signs and symptoms of bad prognosis ===

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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]

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

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

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''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]

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==== Summary ====

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=== Summary ===

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== Vidhi Vimarsha (Applied Inferences ) ==

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==== Contemporary understanding of ''gulma'' ====

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=== Contemporary understanding of ''gulma'' ===

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''.

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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.

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

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

Five regions of the abdomen where ''gulma'' occurs are ''hrid'' (epigastric), ''nabhi'' (umbilical), ''basti'' (hypogastric) and two ''parshva'' (right and left flanks). If both flanks are further subdivided into three ''urdhva'' (upper), ''madhya'' (middle) and ''adho'' (lower), then whole abdomen is divided into 9 parts which is similar to the modern clinical method where abdomen is also divided into nine parts as shown in Table-1. Some of the organs situated in these regions as mentioned by Warner (1964) are also depicted therein and on that basis exact location of the Gulma can be traced.

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===== Table1. Nine divisions of the abdomen, according to [[Ayurveda]] and allopathic medicine =====

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==== Table1. Nine divisions of the abdomen, according to [[Ayurveda]] and allopathic medicine ====

{| class="wikitable"

|-

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|}

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==== Differential diagnosis of ''gulma'' ====

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=== Differential diagnosis of ''gulma'' ===

[[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.

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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.

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

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

'''Principles''':

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#''Tamra bhasma''

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===== Internal Medicines =====

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==== Internal Medicines ====

{| class="wikitable"

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|}

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===== [[Panchakarma]] =====

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==== [[Panchakarma]] ====

{| class="wikitable"

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| ''-''

|}

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~~=== Glossary ===~~

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~~#Agni-karma (अग्निकर्म) cauterization~~

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~~#Ānāha (आनाह) distension of abdomen~~

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~~#Apakva Gulma (अपक्व गुल्म) non-suppurate Gulma~~

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~~#Gulma (गुल्म) palpable mass in abdomen, abdominal lump~~

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~~#Kriyākramaḥ (क्रियाक्रमः) management~~

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~~#Kṣāra karma (क्षारकर्म) application of special alkali preparation~~

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~~#Kṣaratva (क्षरत्व) erosion~~

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~~#Kṣira-Basti (क्षीरबस्ति) Basti prepared with milk~~

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~~#Mahāvāstuṁ (महावास्तुं) involving extensive area~~

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~~#Nicaya Gulma (निचय गुल्म) Tridoṣaja Gulma~~

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~~#Sparśāsahaḥ (स्पर्शासहः) tenderness~~

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~~#Sthānasaṁsthānarujāṁ vikalpaṁ (स्थानसंस्थानरुजां विकल्पं) frequent change in the site, shape and pain of the lump~~

=== Related Chapter ===

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* [[Gulma Nidana]]

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=== ~~References~~ ===

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=== Further reading ===

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#~~Bhāvaprakāsha~~: ~~Bhāvaprakāsha~~ . Published by ~~Chaukhamba~~ Sanskrit Series office Banaras. Cikitsa Prakarana

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

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

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

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

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

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

+

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

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