Gulma Nidana - Revision history

Agnivesha at 08:04, 23 February 2024

2024-02-23T08:04:20Z

← Older revision		Revision as of 08:04, 23 February 2024
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	\|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		\|label6 = Translator and commentator
	\|data6 = Sahu M., Fatmi U., Deole Y. S.		\|data6 = Sahu M., Fatmi U., [[Yogesh Deole\|Deole Y. S.]]
	\|label7 = Reviewer		\|label7 = Reviewer
	\|data7 = Kar A.C., Gadgil D.		\|data7 = Kar A.C., Gadgil D.
	\|label8 = Editors		\|label8 = Editors
	\|data8 = Khandel S.K., Godatwar P., Deole Y.S., Basisht G.		\|data8 = Khandel S.K., Godatwar P., [[Yogesh Deole\|Deole Y.S.]], [[Gopal Basisht\|Basisht G.]]
	\|label9 = Year of publication		\|label9 = Year of publication
	\|data9 = 2020		\|data9 = 2020

Agnivesha at 16:54, 6 March 2023

2023-03-06T16:54:33Z

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	}}		}}

	<big>'''Nidana Sthana Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps '''</big>		<big>'''Nidana Sthana Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps '''</big>
	{{Infobox		{{Infobox
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	<big>'''Abstract'''</big>		<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>
	<~~div~~ 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. </~~div~~>

	'''Keywords''': ''Gulma, mahasrotas, koshtha, dhatukshaya, avarana'', abdominal lumps, intra-abdominal swellings, tumors.		'''Keywords''': ''Gulma, mahasrotas, koshtha, dhatukshaya, avarana'', abdominal lumps, intra-abdominal swellings, tumors.

Agnivesha at 06:05, 20 September 2022

2022-09-20T06:05:26Z

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	{{#seo:		{{#seo:
	\|title=Gulma Nidana		\|title=Gulma Nidana

Eganeesh: /* Related Chapters */

2021-09-23T12:37:09Z

Related Chapters

← Older revision		Revision as of 12:37, 23 September 2021
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	* [[Gulma Chikitsa]]		* [[Gulma Chikitsa]]

			<big>'''[[Special:ContactMe\|Send us your suggestions and feedback on this page.]]'''</big>

	== References ==		== References ==

Eganeesh: /* Location of gulma */

2021-07-10T10:51:51Z

Location of gulma

← Older revision		Revision as of 10:51, 10 July 2021
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	=== Location of ''gulma'' ===		=== 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 ''~~pittagulma~~'' occurs most commonly in the ''nabhi'' region, and ''~~kaphagulma~~'' 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>		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:		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:
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	'''Prognosis''' –''Sannipatika gulma'' is incurable, rest four are curable when treated timely.		'''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 ''~~doshas~~''. 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''.		'''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''.

	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.		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.

Eganeesh: /* Shadkriyakala (lifecycle) of Gulma */

2021-07-10T10:50:11Z

Shadkriyakala (lifecycle) of Gulma

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	=== ''Shadkriyakala'' (lifecycle) 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.		#''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''.		#''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.		#''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 ''~~doshas~~'' 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.		#''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.		#''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.		#''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'' ===		=== Location of ''gulma'' ===

Eganeesh: /* Etiopathogenesis of gulma */

2021-07-10T10:48:47Z

Etiopathogenesis of gulma

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	=== Etiopathogenesis of ''gulma'' ===		=== Etiopathogenesis of ''gulma'' ===

	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 [[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]], 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 ''~~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 analysing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''~~doshas~~'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''~~doshas~~'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear.		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'').		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'').

	=== ''Shadkriyakala'' (lifecycle) of ''Gulma'' ===		=== ''Shadkriyakala'' (lifecycle) of ''Gulma'' ===

Eganeesh: /* Tattva Vimarsha (Fundamental Principles) */

2021-07-10T10:44:35Z

Tattva Vimarsha (Fundamental Principles)

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	== Tattva Vimarsha (Fundamental Principles) ==		== Tattva Vimarsha (Fundamental Principles) ==
	<div style="text-align:justify;">		<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.		*''Gulma'' is a disease of the ''mahastrotas'' (gastro-intestinal tract/abdomen) and is caused due to predominance of ''[[vata]]''. It is of five types depending upon its location (limited to the gastro-intestinal region between the heart and the bladder). Four types of ''gulma'' are common to both males and females while the fifth, ''raktaja gulma'', is a condition limited to females.
	*''Gulmas'' also vary by the vitiation of other ~~doshas~~ besides ''vata''. The ''sannipitaka gulma'', caused by vitiation of all three ''~~doshas~~'', is said to be incurable.		*''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.		*A primary feature of ''gulma'' is obstruction to the path of ''[[vata]]'', which can be due to causes like tumor, stricture, inflammation, tuberculosis, parasites, etc.
	*''Gulma'' with acute symptoms should have urgent relief of ''vata'' obstruction.		*''Gulma'' with acute symptoms should have urgent relief of ''[[vata]]'' obstruction.
	*Treatment of ''vata gulma'' includes ''vata''-alleviating unction, fomentation, mild unctuous purgation, enema, and use of sweet, sour and salty substances. If ''vata dosha'' is pacified in ''gulma'' disease, then other two ''dosha'' can also be controlled.		*Treatment of ''[[vata]] gulma'' includes ''[[vata]]''-alleviating unction, fomentation, mild unctuous purgation, enema, and use of sweet, sour and salty substances. If ''[[vata dosha]]'' is pacified in ''gulma'' disease, then other two ''[[dosha]]'' can also be controlled.

	== Vidhi Vimarsha (Applied Inferences) ==		== Vidhi Vimarsha (Applied Inferences) ==

Eganeesh: /* Sanskrit Text, Transliteration and English Translation */

2021-07-10T10:43:06Z

Sanskrit Text, Transliteration and English Translation

Show changes

Eganeesh at 09:35, 10 July 2021

2021-07-10T09:35:58Z

← Older revision		Revision as of 09:35, 10 July 2021
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	<big>'''Abstract'''</big>		<big>'''Abstract'''</big>

	<div 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. </div>		<div 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. </div>

	'''Keywords''': ''Gulma, mahasrotas, koshtha, dhatukshaya, avarana'', abdominal lumps, intra-abdominal swellings, tumors.		'''Keywords''': ''Gulma, mahasrotas, koshtha, dhatukshaya, avarana'', abdominal lumps, intra-abdominal swellings, tumors.
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	<div style="text-align:justify;">		<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 ''~~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 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 vitiated ''vata'', in conjunction with other ''~~doshas~~'', 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:		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),
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	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.
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	==Sanskrit Text, Transliteration and English Translation==		==Sanskrit Text, Transliteration and English Translation==
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	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 ===		=== Agnivesha’s question ===