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Gulma Chikitsa (view source)

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{{#seo:

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|title=Gulma Chikitsa

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|titlemode=append

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|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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}}

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

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

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अथातो गुल्मचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātō gulmacikitsitaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

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

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सर्वप्रजानां पितृवच्छरण्यः पुनर्वसुर्भूतभविष्यदीशः|

चिकित्सितं गुल्मनिबर्हणार्थं प्रोवाच सिद्धं वदतां वरिष्ठः||३||

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sarvaprajānāṁ pitr̥vaccharaṇyaḥ punarvasurbhūtabhaviṣyadīśaḥ|

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cikitsitaM gulmanibarhaNArthaM provAca siddhaM vadatAM variShThaH||3||

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</div></div>

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]

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

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विट्श्लेष्मपित्तातिपरिस्रवाद्वा तैरेव वृद्धैः परिपीडनाद्वा|

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विचेष्टितैर्वा विषमातिमात्रैः कोष्ठे प्रकोपं समुपैति वायुः||५||

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viṭślēṣmapittātiparisravādvā tairēva vr̥ddhaiḥ paripīḍanādvā|

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viceShTitairvA viShamAtimAtraiH koShThe prakopaM samupaiti vAyuH||5||

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</div></div>

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

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

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कफं च पित्तं च स दुष्टवायुरुद्धूय मार्गान् विनिबद्ध्य ताभ्याम्|

हृन्नाभिपार्श्वोदरबस्तिशूलं करोत्यथो याति न बद्धमार्गः||६||

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kaphaṁ ca pittaṁ ca sa duṣṭavāyuruddhūya mārgān vinibaddhya tābhyām|

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hRunnAbhipArshvodarabastishUlaM karotyatho yAti na baddhamArgaH||6||

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</div></div>

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

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

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पक्वाशये पित्तकफाशये वा स्थितः स्वतन्त्रः परसंश्रयो वा|

स्पर्शोपलभ्यः परिपिण्डितत्वाद्गुल्मो यथादोषमुपैति नाम||७||

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pakvāśayē pittakaphāśayē vā sthitaḥ sVātantraḥ parasaṁśrayō vā|

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sparshopalabhyaH paripiNDitatvAdgulmo yathAdoShamupaiti nAma||7||

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</div></div>

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

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

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बस्तौ च ना भ्यां हृदि पार्श्वयोर्वा स्थानानि गुल्मस्य भवन्ति पञ्च|

पञ्चात्मकस्य प्रभवं तु तस्य वक्ष्यामि लिङ्गानि चिकित्सितं च||८||

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bastau ca nābhyāṁ hr̥di pārśvayōrvā sthānāni gulmasya bhavanti pañca|8|

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pa~jcAtmakasya prabhavaM tu tasya vakShyAmi li~ggAni cikitsitaM ca||8||

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</div></div>

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]

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

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रूक्षान्नपानं विषमातिमात्रं विचेष्टितं वेगविनिग्रहश्च|

शोकोऽभिघातोऽतिमलक्षयश्च निरन्नता चानिलगुल्महेतुः||९||

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rūkṣānnapānaṁ viṣamātimātraṁ vicēṣṭitaṁ vēgavinigrahaśca|

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shoko~abhighAto~atimalakShayashca nirannatA cAnilagulmahetuH||9||

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</div></div>

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]

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

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यः स्थानसंस्थानरुजां विकल्पं विड्वातसङ्गं गलवक्त्रशोषम्|

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वातात् स गुल्मो न च तत्र रूक्षं कषायतिक्तं कटु चोपशेते||११||

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yaḥ sthānasaṁsthānarujāṁ vikalpaṁ viḍvātasaṅgaṁ galavaktraśōṣam|

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vAtAt sa gulmo na ca tatra rUkShaM kaShAyatiktaM kaTu copashete||11||

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</div></div>

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]

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

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कट्वम्लतीक्ष्णोष्णविदाहिरूक्षक्रोधातिमद्यार्कहुताशसेवा|

आमाभिघातो रुधिरं च दुष्टं पैत्तस्य गुल्मस्य निमित्तमुक्तम्||१२||

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kaṭvamlatīkṣṇōṣṇavidāhirūkṣakrōdhātimadyārkahutāśasēvā|

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AmAbhighAto [2] rudhiraM ca duShTaM paittasya gulmasya nimittamuktam||12||

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</div></div>

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]

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

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ज्वरः पिपासा वदनाङ्गरागः शूलं महज्जीर्यति भोजने च|

स्वेदो विदाहो व्रणवच्च गुल्मः स्पर्शासहः पैत्तिकगुल्मरूपम्||१३||

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jvaraḥ pipāsā vadanāṅgarāgaḥ śūlaṁ mahajjīryati bhōjanē ca|

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svedo vidAho vraNavacca gulmaH sparshAsahaH paittikagulmarUpam||13||

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</div></div>

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]

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

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शीतं गुरु स्निग्धमचेष्टनं च सम्पूरणं प्रस्वपनं दिवा च|

गुल्मस्य हेतुः कफसम्भवस्य सर्वस्तु दिष्टो निचयात्मकस्य||१४||

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śītaṁ guru snigdhamacēṣṭanaṁ ca sampūraṇaṁ prasvapanaṁ divā ca|

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gulmasya hetuH kaphasambhavasya sarvastu diShTo nicayAtmakasya||14||

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</div></div>

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

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

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स्तैमित्यशीतज्वरगात्रसादहृल्लासकासारुचिगौरवाणि|

शैत्यं रुगल्पा कठिनोन्नतत्वं गुल्मस्य रूपाणि कफात्मकस्य||१५||

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staimityaśītajvaragātrasādahr̥llāsakāsārucigauravāṇi|

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shaityaM rugalpA kaThinonnatatvaM gulmasya rUpANi kaphAtmakasya||15||

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</div></div>

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]

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

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निमित्तलिङ्गान्युपलभ्य गुल्मे द्विदोषजे दोषबलाबलं च|

व्यामिश्रलिङ्गानपरांस्तु गुल्मांस्त्रीनादिशेदौषधकल्पनार्थम्||१६||

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nimittaliṅgānyupalabhya gulmē dvidōṣajē dōṣabalābalaṁ ca|

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vyAmishrali~ggAnaparAMstu gulmAMstrInAdishedauShadhakalpanArtham||16||

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</div></div>

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

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

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महारुजं दाहपरीतमश्मवद्घनोन्नतं शीघ्रविदाहि दारुणम्|

मनःशरीराग्निबलापहारिणं त्रिदोषजं गुल्ममसाध्यमादिशेत्||१७||

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mahārujaṁ dāhaparītamaśmavadghanōnnataṁ śīghravidāhi dāruṇam|

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manaHsharIrAgnibalApahAriNaM tridoShajaM gulmamasAdhyamAdishet||17||

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</div></div>

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]

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

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ऋतावनाहारतया भयेन विरूक्षणैर्वेगविनिग्रहैश्च|

संस्तम्भनोल्लेखनयोनिदोषैर्गुल्मः स्त्रियं रक्तभवोऽभ्युपैति||१८||

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r̥tāvanāhāratayā bhayēna virūkṣaṇairvēgavinigrahaiśca|

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saMstambhanollekhanayonidoShairgulmaH striyaM raktabhavo~abhyupaiti||18||

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</div></div>

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]

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

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यः स्पन्दते पिण्डित एव नाङ्गैश्चिरात् सशूलः समगर्भलिङ्गः|

स रौधिरः स्त्रीभव एव गुल्मो मासे व्यतीते दशमे चिकित्स्यः||१९||

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yaḥ spandatē piṇḍita ēva nāṅgaiścirāt saśūlaḥ samagarbhaliṅgaḥ|

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sa raudhiraH strIbhava eva gulmo mAse vyatIte dashame cikitsyaH||19||

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</div></div>

The lump slowly grows in the form of round mass which has pulsation as a whole but not in its part. It is associated with acute pain and signs and symptoms mimicking pregnancy. ''Raktaja gulma'' occurs only in women and should be treated after the completion of ten months [19]

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क्रियाक्रममतः सिद्धं गुल्मिनां गुल्मनाशनम्|

प्रवक्ष्याम्यत ऊर्ध्वं च योगान् गुल्मनिबर्हणान्||२०||

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kriyākramamataḥ siddhaṁ gulmināṁ gulmanāśanam|

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pravakShyAmyata UrdhvaM ca yogAn gulmanibarhaNAn||20||

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</div></div>

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]

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

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रूक्षव्यायामजं गुल्मं वातिकं तीव्रवेदनम्|

बद्धविण्मारुतं स्नेहैरादितः समुपाचरेत्||२१||

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rūkṣavyāyāmajaṁ gulmaṁ vātikaṁ tīvravēdanam|

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baddhaviNmArutaM snehairAditaH samupAcaret||21||

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</div></div>

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

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

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भोजनाभ्यञ्जनैः पानैर्निरूहैः सानुवासनैः|

स्निग्धस्य भिषजा स्वेदः कर्तव्यो गुल्मशान्तये||२२||

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bhōjanābhyañjanaiḥ pānairnirūhaiḥ sānuvāsanaiḥ|

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snigdhasya bhiShajA svedaH kartavyo gulmashAntaye||22||

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</div></div>

''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]

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

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स्रोतसां मार्दवं कृत्वा जित्वा मारुतमुल्बणम्|

भित्त्वा विबन्धं स्निग्धस्य स्वेदो गुल्ममपोहति||२३||

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srōtasāṁ mārdavaṁ kr̥tvā jitvā mārutamulbaṇam|

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bhittvA vibandhaM snigdhasya svedo gulmamapohati||23||

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</div></div>

''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]

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

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स्नेहपानं हितं गुल्मे विशेषेणोर्ध्वनाभिजे|

पक्वाशयगते बस्तिरुभयं जठराश्रये||२४||

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snēhapānaṁ hitaṁ gulmē viśēṣēṇōrdhvanābhijē|

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pakvAshayagate bastirubhayaM jaTharAshraye||24||

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</div></div>

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

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दीप्तेऽग्नौ वातिके गुल्मे विबन्धेऽनिलवर्चसोः|

बृंहणान्यन्नपानानि स्निग्धोष्णानि प्रयोजयेत्||२५||

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dīptē'gnau vātikē gulmē vibandhē'nilavarcasōḥ|

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bRuMhaNAnyannapAnAni snigdhoShNAni prayojayet||25||

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</div></div>

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

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

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पुनः पुनः स्नेहपानं निरूहाः सानुवासनाः|

प्रयोज्या वातगुल्मेषु कफपित्तानुरक्षिणा||२६||

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punaḥ punaḥ snēhapānaṁ nirūhāḥ sānuvāsanāḥ|

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prayojyA vAtagulmeShu kaphapittAnurakShiNA||26||

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</div></div>

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

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कफो वाते जितप्राये पित्तं शोणितमेव वा|

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आदावन्ते च मध्ये च मारुतं परिरक्षता||२८||

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kaphō vātē jitaprāyē pittaṁ śōṇitamēva vā|

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AdAvante ca madhye ca mArutaM parirakShatA||28||

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</div></div>

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

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

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वातगुल्मे कफो वृद्धो हत्वाऽग्निमरुचिं यदि|

हृल्लासं गौरवं तन्द्रां जनयेदुल्लिखेत्तु तम्||२९||

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vātagulmē kaphō vr̥ddhō hatvā'gnimaruciṁ yadi|

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hRullAsaM gauravaM tandrAM janayedullikhettu tam||29||

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</div></div>

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

+

शूलानाहविबन्धेषु गुल्मे वातकफोल्बणे|

वर्तयो गुटिकाश्चूर्णं कफवातहरं हितम्||३०||

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śūlānāhavibandhēṣu gulmē vātakaphōlbaṇē|

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vartayo guTikAshcUrNaM kaphavAtaharaM hitam||30||

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</div></div>

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

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

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पित्तं वा यदि संवृद्धं सन्तापं वातगुल्मिनः|

कुर्याद्विरेच्यः स भवेत् सस्नेहैरानुलोमिकैः||३१||

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pittaṁ vā yadi saṁvr̥ddhaṁ santāpaṁ vātagulminaḥ|

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kuryAdvirecyaH sa bhavet sasnehairAnulomikaiH||31||

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</div></div>

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

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

+

गुल्मो यद्यनिलादीनां कृते सम्यग्भिषग्जिते|

न प्रशाम्यति रक्तस्य सोऽवसेकात् प्रशाम्यति||३२||

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gulmō yadyanilādīnāṁ kr̥tē samyagbhiṣagjitē|

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na prashAmyati raktasya so~avasekAt prashAmyati||32||

+

</div></div>

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

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

+

स्निग्धोष्णेनोदिते गुल्मे पैत्तिके स्रंसनं हितम्|

रूक्षोष्णेन तु सम्भूते सर्पिः प्रशमनं परम्||३३||

+

snigdhōṣṇēnōditē gulmē paittikē sraṁsanaṁ hitam|

Line 536: Line 629:

rUkShoShNena tu sambhUte sarpiH prashamanaM param||33||

+

</div></div>

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

+

पित्तं वा पित्तगुल्मं वा ज्ञात्वा पक्वाशयस्थितम्|

Line 546: Line 641:

भिषगग्निबलापेक्षी सर्पिषा तैल्वकेन वा||३५||

+

pittaṁ vā pittagulmaṁ vā jñātvā pakvāśayasthitam|

Line 562: Line 658:

bhiShagagnibalApekShI sarpiShA tailvakena vA||35||

+

</div></div>

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

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

+

तृष्णाज्वरपरीदाहशूलस्वेदाग्निमार्दवे|

गुल्मिनामरुचौ चापि रक्तमेवावसेचयेत्||३६||

+

tr̥ṣṇājvaraparīdāhaśūlasvēdāgnimārdavē|

Line 578: Line 677:

gulminAmarucau cApi raktamevAvasecayet||36||

+

</div></div>

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

+

छिन्नमूला विदह्यन्ते न गुल्मा यान्ति च क्षयम्|

रक्तं हि व्यम्लतां याति, तच्च नास्ति न चास्ति रुक्||३७||

+

chinnamūlā vidahyantē na gulmā yānti ca kṣayam|

Line 592: Line 694:

raktaM hi vyamlatAM yAti, tacca nAsti na cAsti ruk||37||

+

</div></div>

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

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

+

हृतदोषं परिम्लानं जाङ्गलैस्तर्पितं रसैः|

समाश्वस्तं सशेषार्तिं सर्पिरभ्यासयेत् पुनः||३८||

+

hr̥tadōṣaṁ parimlānaṁ jāṅgalaistarpitaṁ rasaiḥ|

Line 608: Line 713:

samAshvastaM sasheShArtiM sarpirabhyAsayet punaH||38||

+

</div></div>

The patient may become weak due to elimination of vitiated blood; hence he should be nourished by the diet comprising of meat soup of wild animals and comforted. To pacify the remaining complaints, he should be prescribed the medicated ghee again [38]

+

रक्तपित्तातिवृद्धत्वात् क्रियामनुपलभ्य च|

यदि गुल्मो विदह्येत शस्त्रं तत्र भिषग्जितम्||३९||

+

raktapittātivr̥ddhatvāt kriyāmanupalabhya ca|

Line 622: Line 730:

yadi gulmo vidahyeta shastraM tatra bhiShagjitam||39||

+

</div></div>

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

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

+

गुरुः कठिनसंस्थानो गूढमांसान्तराश्रयः|

अविवर्णः स्थिरश्चैव ह्यपक्वो गुल्म उच्यते||४०||

+

guruḥ kaṭhinasaṁsthānō gūḍhamāṁsāntarāśrayaḥ|

Line 638: Line 749:

avivarNaH sthirashcaiva hyapakvo gulma ucyate||40||

+

</div></div>

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]

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

+

दाहशूलार्तिसङ्क्षोभस्वप्ननाशारतिज्वरैः|

विदह्यमानं जानीयाद्गुल्मं तमुपनाहयेत्||४१||

+

dāhaśūlārtisaṅkṣōbhasvapnanāśāratijvaraiḥ|

Line 654: Line 768:

vidahyamAnaM jAnIyAdgulmaM tamupanAhayet||41||

+

</div></div>

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]

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

+

विदाहलक्षणे गुल्मे बहिस्तुङ्गे समुन्नते|

Line 666: Line 782:

तत्रैव पिण्डिते शूले सम्पक्वं गुल्ममादिशेत्||४३||

+

vidāhalakṣaṇē gulmē bahistuṅgē samunnatē|

Line 682: Line 799:

tatraiva piNDite shUle sampakvaM gulmamAdishet||43||

+

</div></div>

If ''gulma'' protrudes pointing toward outside and skin over the lesion becomes stiff and numb and its color changes to dusky with red margins. On palpation, the lump resembles as bladder filled with water, pitting on pressure, but on pressing from side the mass becomes tense with mild pain, otherwise it feels compressed mass with acute pain; all these signs and symptoms indicate that the ''gulma'' has suppurated [42-43]

+

तत्र धान्वन्तरीयाणामधिकारः क्रियाविधौ|

वैद्यानां कृतयोग्यानां व्यधशोधनरोपणे||४४||

+

tatra dhānvantarīyāṇāmadhikāraḥ kriyāvidhau|

Line 696: Line 816:

vaidyAnAM kRutayogyAnAM vyadhashodhanaropaNe||44||

+

</div></div>

The suppurated ''gulma'' requires surgical intervention such as incision, cleansing and healing therefore it should be treated by a surgeon [44]

+

अन्तर्भागस्य चाप्येतत् पच्यमानस्य लक्षणम्|

हृत्क्रोडशूनताऽन्तःस्थे [५] बहिःस्थे पार्श्वनिर्गतिः||४५||

+

antarbhāgasya cāpyētat pacyamānasya lakṣaṇam|

Line 710: Line 833:

hRutkroDashUnatA~antaHsthe [5] bahiHsthe pArshvanirgatiH||45||

+

</div></div>

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]

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

+

पक्वः स्रोतांसि सङ्क्लेद्य व्रजत्यूर्ध्वमधोऽपि वा|

Line 720: Line 845:

दशाहं द्वादशाहं वा रक्षन् भिषगुपद्रवान्|

+

pakvaḥ srōtāṁsi saṅklēdya vrajatyūrdhvamadhō'pi vā|

Line 732: Line 858:

dashAhaM dvAdashAhaM vA rakShan bhiShagupadravAn|

+

</div></div>

Suppurated ''gulma'' on softening of the passage discharges the pus upwards or downwards. In case of ''gulma'' starts discharging at its own then the physician should wait and watch for ten or twelve days while taking care that no complication occurs [46]

+

अत ऊर्ध्वं हितं पानं सर्पिषः सविशोधनम्||४७||

शुद्धस्य तिक्तं सक्षौद्रं प्रयोगे सर्पिरिष्यते|४८|

+

ata ūrdhvaṁ hitaṁ pānaṁ sarpiṣaḥ saviśōdhanam||47||

Line 746: Line 875:

shuddhasya tiktaM sakShaudraM prayoge sarpiriShyate|48|

+

</div></div>

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

Line 752: Line 882:

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

+

शीतलैर्गुरुभिः स्निग्धैर्गुल्मे जाते कफात्मके||४८||

अवम्यस्याल्पकायाग्नेः कुर्याल्लङ्घनमादितः|

+

śītalairgurubhiḥ snigdhairgulmē jātē kaphātmakē||48||

Line 764: Line 896:

avamyasyAlpakAyAgneH kuryAlla~gghanamAditaH|

+

</div></div>

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

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

+

मन्दोऽग्निर्वेदना मन्दा गुरुस्तिमितकोष्ठता||४९||

सोत्क्लेशा चारुचिर्यस्य स गुल्मी वमनोपगः|

+

mandō'gnirvēdanā mandā gurustimitakōṣṭhatā||49||

Line 780: Line 915:

sotkleshA cAruciryasya sa gulmI vamanopagaH|

+

</div></div>

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

+

उष्णैरेवोपचर्यश्च कृते वमनलङ्घने||५०||

योज्यश्चाहारसंसर्गो भेषजैः कटुतिक्तकैः|

+

uṣṇairēvōpacaryaśca kr̥tē vamanalaṅghanē||50||

Line 794: Line 932:

yojyashcAhArasaMsargo bheShajaiH kaTutiktakaiH|

+

</div></div>

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

+

सानाहं सविबन्धं च गुल्मं कठिनमुन्नतम्||५१||

दृष्ट्वाऽऽदौ स्वेदयेद्युक्त्या स्विन्नं च विलयेद्भिषक्|

+

sānāhaṁ savibandhaṁ ca gulmaṁ kaṭhinamunnatam||51||

Line 808: Line 949:

dRuShTvA~a~adau svedayedyuktyA svinnaM ca vilayedbhiShak|

+

</div></div>

If the ''gulma'' is hard and protruded accompanied with constipation and distension of abdomen then physician should give sudation locally to dissolve it [51]

+

लङ्घनोल्लेखने स्वेदे कृतेऽग्नौ सम्प्रधुक्षिते||५२||

कफगुल्मी पिबेत् काले सक्षारकटुकं घृतम्|

+

laṅghanōllēkhanē svēdē kr̥tē'gnau sampradhukṣitē||52||

Line 822: Line 966:

kaphagulmI pibet kAle sakShArakaTukaM ghRutam|

+

</div></div>

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

+

स्थानादपसृतं ज्ञात्वा कफगुल्मं विरेचनैः||५३||

सस्नेहैर्बस्तिभिर्वाऽपि शोधयेद्दाशमूलिकैः|

+

sthānādapasr̥taṁ jñātvā kaphagulmaṁ virēcanaiḥ||53||

Line 836: Line 983:

sasnehairbastibhirvA~api shodhayeddAshamUlikaiH|

+

</div></div>

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

+

मन्देऽग्नावनिले मूढे ज्ञात्वा सस्नेहमाशयम्||५४||

गुटिकाचूर्णनिर्यूहाः प्रयोज्याः कफगुल्मिनाम्|

+

mandē'gnāvanilē mūḍhē jñātvā sasnēhamāśayam||54||

Line 850: Line 1,000:

guTikAcUrNaniryUhAH prayojyAH kaphagulminAm|

+

</div></div>

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

+

कृतमूलं महावास्तुं कठिनं स्तिमितं गुरुम्||५५||

जयेत्कफकृतं गुल्मं क्षारारिष्टाग्निकर्मभिः||

+

kr̥tamūlaṁ mahāvāstuṁ kaṭhinaṁ stimitaṁ gurum||55||

Line 864: Line 1,017:

jayetkaphakRutaM gulmaM kShArAriShTAgnikarmabhiH|56|

+

</div></div>

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

+

दोषप्रकृतिगुल्मर्तुयोगं बुद्ध्वा कफोल्बणे||५६||

Line 874: Line 1,029:

शरीरबलदोषाणां वृद्धिक्षपणकोविदः|

+

dōṣaprakr̥tigulmartuyōgaṁ buddhvā kaphōlbaṇē||56||

Line 890: Line 1,046:

sharIrabaladoShANAM vRuddhikShapaNakovidaH|

+

</div></div>

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

+

श्लेष्माणं मधुरं स्निग्धं मांसक्षीरघृताशिनः||५८||

छित्त्वा छित्त्वाऽऽशयात् क्षारः क्षरत्वात क्षारयत्यधः|

+

ślēṣmāṇaṁ madhuraṁ snigdhaṁ māṁsakṣīraghr̥tāśinaḥ| |58||

Line 904: Line 1,063:

chittvA chittvA~a~ashayAt kShAraH kSharatvAta kShArayatyadhaH|

+

</div></div>

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

+

मन्देऽग्नावरुचौ सात्म्ये मद्ये सस्नेहमश्नताम्||५९||

प्रयोज्या मार्गशुद्ध्यर्थमरिष्टाः कफगुल्मिनाम्||

+

mandē'gnāvarucau sātmyē madyē sasnēhamaśnatām||59||

Line 918: Line 1,080:

prayojyA mArgashuddhyarthamariShTAH kaphagulminAm|60|

+

</div></div>

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

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

+

लङ्घनोल्लेखनैः स्वेदैः सर्पिःपानैर्विरेचनैः||६०||

Line 930: Line 1,094:

तस्य दाहो हृते रक्ते शरलोहादिभिर्हितः|

+

laṅghanōllēkhanaiḥ svēdaiḥ sarpiḥpānairvirēcanaiḥ||60||

Line 946: Line 1,111:

tasya dAho hRute rakte sharalohAdibhirhitaH|

+

</div></div>

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

+

औष्ण्यात्तैक्ष्ण्याच्च शमयेदग्निर्गुल्मे कफानिलौ||६२||

तयोः शमाच्च सङ्घातो गुल्मस्य विनिवर्तते|

+

auṣṇyāttaikṣṇyācca śamayēdagnirgulmē kaphānilau||62||

Line 960: Line 1,128:

tayoH shamAcca sa~gghAto gulmasya vinivartate|

+

</div></div>

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

+

दाहे धान्वन्तरीयाणामत्रापि भिषजां बलम्||६३||

क्षारप्रयोगे भिषजां क्षारतन्त्रविदां बलम्||

+

dāhē dhānvantarīyāṇāmatrāpi bhiṣajāṁ balam||63||

Line 974: Line 1,145:

kShAraprayoge bhiShajAM kShAratantravidAM balam|64|

+

</div></div>

Cauterization comes under the purview of the surgeon and the use of ''kshara'' is the field of specialist in ''kshara karma'' [63]

+

व्यामिश्रदोषे व्यामिश्र एष एव क्रियाक्रमः||६४||

+

vyāmiśradōṣē vyāmiśra ēṣa ēva kriyākramaḥ||64||

vyAmishradoShe vyAmishra eSha eva kriyAkramaH||64||

+

</div></div>

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

+

सिद्धानतः प्रवक्ष्यामि योगान् गुल्मनिबर्हणान्|

+

siddhānataḥ pravakṣyāmi yōgān gulmanibarhaṇān|

siddhAnataH pravakShyAmi yogAn gulmanibarhaNAn|

+

</div></div>

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

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

+

त्र्यूषणत्रिफलाधान्यविडङ्गचव्यचित्रकैः||६५||

कल्कीकृतैर्घृतं सिद्धं सक्षीरं वातगुल्मनुतिति त्र्यूषणादिघृतम् |

+

tryūṣaṇatriphalādhānyaviḍaṅgacavyacitrakaiḥ||65||

Line 1,006: Line 1,186:

kalkIkRutairghRutaM siddhaM sakShIraM vAtagulmanutiti tryUShaNAdighRutam |

+

</div></div>

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

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

+

एत एव च कल्काः स्युः कषायः पाञ्चमूलिकः ||६६||

द्विपञ्चमूलिको वाऽपि तद्घृतं गुल्मनुत् परमिति त्र्यूषणादिघृतमपरम्

+

ēta ēva ca kalkāḥ syuḥ kaṣāyaḥ pāñcamūlikaḥ ||66||

Line 1,022: Line 1,205:

dvipa~jcamUliko vA~api tadghRutaM gulmanut paramiti tryUShaNAdighRutamaparam

+

</div></div>

Above mentioned paste if prepared with decoction of ''brihat panchamula'' or ''dashamula'' is known as ''parama tryushanadighritama''. It is very much effective in curing ''gulma''; thus described ''parama tryushanadighritama'' [66]

+

(षट्पलं वा पिबेत् सर्पिर्यदुक्तं राजयक्ष्मणि)||६७||

+

(ṣaṭpalaṁ vā pibētsarpiryaduktaṁ rājayakṣmaṇi)||67||

(ShaTpalaM vA pibetsarpiryaduktaM rAjayakShmaNi)||67||

+

</div></div>

(''shatpalam ghrita'' described for the treatment of ''rajayakshma'' may also be used orally) [67]

+

प्रसन्नया वा क्षीरार्थं सुरया दाडिमेन वा|

दध्नः सरेण वा कार्यं घृतं मारुतगुल्मनुत्||६८||

+

prasannayā vā kṣīrārthaṁ surayā dāḍimēna vā|

Line 1,044: Line 1,233:

dadhnaH sareNa vA kAryaM ghRutaM mArutagulmanut||68||

+

</div></div>

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

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

+

हिङ्गुसौवर्चलाजाजीबिडदाडिमदीप्यकैः|

Line 1,058: Line 1,249:

इति हिङ्गुसौवर्चलाद्यं घृतम्

+

hiṅgusauvarcalājājībiḍadāḍimadīpyakaiḥ|

Line 1,078: Line 1,270:

iti hi~ggusauvarcalAdyaM ghRutam

+

</div></div>

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

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

+

हपुषाव्योषपृथ्वीकाचव्यचित्रकसैन्धवैः|

Line 1,096: Line 1,290:

इति हपुषाद्यं घृतम्

+

hapuṣāvyōṣapr̥thvīkācavyacitrakasaindhavaiḥ|

Line 1,124: Line 1,319:

iti hapuShAdyaM ghRutam

+

</div></div>

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

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

+

पिप्पल्या पिचुरध्यर्धो दाडिमाद्द्विपलं पलम्|

Line 1,138: Line 1,335:

इति पिप्पल्याद्यं घृतम्

+

pippalyā picuradhyardhō dāḍimāddvipalaṁ palam|

Line 1,158: Line 1,356:

iti pippalyAdyaM ghRutam

+

</div></div>

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

+

घृतानामौषधगणा य एते परिकीर्तिताः|

ते चूर्णयोगा वर्त्यस्ताः कषायास्ते च गुल्मिनाम्||७६||

+

ghr̥tānāmauṣadhagaṇā ya ētē parikīrtitāḥ|

Line 1,172: Line 1,373:

te cUrNayogA vartyastAH kaShAyAste ca gulminAm||76||

+

</div></div>

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]

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

+

कोलदाडिमघर्माम्बुसुरामण्डाम्लकाञ्जिकैः|

शूलानाहहरी पेया बीजपूररसेन वा||७७||

+

kōladāḍimagharmāmbusurāmaṇḍāmlakāñjikaiḥ|

Line 1,188: Line 1,392:

shUlAnAhaharI peyA bIjapUrarasena vA||77||

+

</div></div>

The liquid gruel prepared from jujube, pomegranate, warm water, supernatant liquid of ''sura''(wine) (''sura manda''), sour ''kanji'' or citron juice relieves abdominal pain and distension of abdomen [77]

+

चूर्णानि मातुलुङ्गस्य भावितानि रसेन वा|

कुर्याद्वर्तीः सगुटिका गुल्मानाहार्तिशान्तये||७८||

+

cūrṇāni mātuluṅgasya bhāvitāni rasēna vā|

Line 1,202: Line 1,409:

kuryAdvartIH saguTikA gulmAnAhArtishAntaye||78||

+

</div></div>

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]

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

+

हिङ्गु त्रिकटुकं पाठां हपुषामभयां शटीम्|

Line 1,232: Line 1,441:

इति हिङ्ग्वादिचूर्णं गुटिका च |

+

hiṅgu trikaṭukaṁ pāṭhāṁ hapuṣāmabhayāṁ śaṭīm|

Line 1,284: Line 1,494:

iti hi~ggvAdicUrNaM guTikA ca

+

</div></div>

Make fine powder of equal parts of asafoetida, ''trikatu, patha, hapusha, haritaki, shati, ajamoda, ajagandha, tintidika, amlavetas,'' pomegranate, ''pushkaramula,'' coriander, ''cumin, chitraka, vacha,'' two types of kshara, two types of salt and ''chavya''. It is known as ''hingvadichurnam''.

Line 1,292: Line 1,503:

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

+

मातुलुङ्गरसो हिङ्गु दाडिमं बिडसैन्धवे|

सुरामण्डेन पातव्यं वातगुल्मरुजापहम्||८५||

+

mātuluṅgarasō hiṅgu dāḍimaṁ biḍasaindhavē|

Line 1,304: Line 1,517:

surAmaNDena pAtavyaM vAtagulmarujApaham||85||

+

</div></div>

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

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

+

शटीपुष्करहिङ्ग्वम्लवेतसक्षारचित्रकान्|

Line 1,328: Line 1,543:

पार्श्वहृद्बस्तिशूलं च गुटिकैषा व्यपोहति||९०||

+

śaṭīpuṣkarahiṅgvamlavētasakṣāracitrakān|

Line 1,367: Line 1,583:

pArshvahRudbastishUlaM ca guTikaiShA vyapohati||90||

+

</div></div>

Mix fine powders of ''shati, pushkaramula,'' asafoetida, ''amlavetasa, kshara, chitraka,'' coriander, ''ajwain'' (''yavani''), ''vidanga'', rock-salt, ''vacha, chavya, pippalimula, ajagandha,'' pomegranate, ''ajaji'' and ''ajamoda''. It may be used in powder form or in the form of pills made of size of jujube by impregnating these powders in juice of citron or vinegar of honey by rubbing well.

Line 1,373: Line 1,590:

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

+

नागरार्धपलं पिष्ट्वा द्वे पले लुञ्चितस्य च|

Line 1,379: Line 1,597:

वातगुल्ममुदावर्तं योनिशूलं च नाशयेत्|

+

nāgarārdhapalaṁ piṣṭvā dvē palē luñcitasya ca|

Line 1,391: Line 1,610:

vAtagulmamudAvartaM yonishUlaM ca nAshayet|

+

</div></div>

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

+

पिबेदेरण्डजं तैलं वारुणीमण्डमिश्रितम्||९२||

Line 1,399: Line 1,620:

श्लेष्मण्यनुबले पूर्वं हितं पित्तानुगे परम्||९३||

+

pibēdēraṇḍajaṁ tailaṁ vāruṇīmaṇḍamiśritam||92||

Line 1,411: Line 1,633:

shleShmaNyanubale pUrvaM hitaM pittAnuge param||93||

+

</div></div>

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

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

+

साधयेच्छुद्धशुष्कस्य लशुनस्य चतुष्पलम्|

Line 1,425: Line 1,649:

इति लशुनक्षीरम् |

+

sādhayēcchuddhaśuṣkasya laśunasya catuṣpalam|

Line 1,445: Line 1,670:

iti lashunakShIram

+

</div></div>

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

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

+

तैलं प्रसन्ना गोमूत्रमारनालं यवाग्रजम्|

Line 1,455: Line 1,682:

इति तैलपञ्चकम् |

+

tailaṁ prasannā gōmūtramāranālaṁ yavāgrajam|

Line 1,467: Line 1,695:

iti tailapa~jcakam

+

</div></div>

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]

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

+

पञ्चमूलीकषायेण सक्षारेण शिलाजतु|

Line 1,477: Line 1,707:

इति शिलाजतुप्रयोगः |

+

pañcamūlīkaṣāyēṇa sakṣārēṇa śilājatu|

Line 1,489: Line 1,720:

iti shilAjatuprayogaH

+

</div></div>

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

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

+

वाट्यं पिप्पलीयूषेण मूलकानां रसेन वा|

भुक्त्वा स्निग्धमुदावर्ताद्वातगुल्माद्विमुच्यते||९८||

+

vāṭyaṁ pippalīyūṣēṇa mūlakānāṁ rasēna vā|

Line 1,505: Line 1,739:

bhuktvA snigdhamudAvartAdvAtagulmAdvimucyate||98||

+

</div></div>

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

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

+

शूलानाहविबन्धार्तं स्वेदयेद्वातगुल्मिनम्|

स्वेदैः स्वेदविधावुक्तैर्नाडीप्रस्तरसङ्करैः||९९||

+

śūlānāhavibandhārtaṁ svēdayēdvātagulminam|

Line 1,521: Line 1,758:

svedaiH svedavidhAvuktairnADIprastarasa~gkaraiH||99||

+

</div></div>

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

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

+

बस्तिकर्म परं विद्याद्गुल्मघ्नं तद्धि मारुतम्|

Line 1,535: Line 1,774:

गुल्मघ्ना विविधा दिष्टाः सिद्धाः सिद्धिषु बस्तयः|

+

bastikarma paraṁ vidyādgulmaghnaṁ taddhi mārutam|

Line 1,555: Line 1,795:

gulmaghnA vividhA diShTAH siddhAH siddhiShu bastayaH|

+

</div></div>

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

==== Medicated oils ====

+

गुल्मघ्नानि च तैलानि वक्ष्यन्ते वातरोगिके||१०२||

Line 1,565: Line 1,807:

प्रयुक्तान्याशु सिध्यन्ति तैलं ह्यनिलजित्परम् [१२] ||१०३||

+

gulmaghnāni ca tailāni vakṣyantē vātarōgikē||102||

Line 1,577: Line 1,820:

prayuktAnyAshu sidhyanti tailaM hyanilajitparam [12] ||103||

+

</div></div>

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

+

नीलिनीचूर्णसंयुक्तं पूर्वोक्तं घृतमेव|

समलाय प्रदातव्यं शोधनं वातगुल्मिने||१०४||

+

nīlinīcūrṇasaṁyuktaṁ pūrvōktaṁ ghr̥tamēva|

Line 1,591: Line 1,837:

samalAya pradAtavyaM shodhanaM vAtagulmine||104||

+

</div></div>

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

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

+

नीलिनीत्रिवृतादन्तीपथ्याकम्पिल्लकैः सह|

शोधनार्थं घृतं देयं सबिडक्षारनागरम्||१०५||

+

nīlinītrivr̥tādantīpathyākampillakaiḥ saha|

Line 1,607: Line 1,856:

shodhanArthaM ghRutaM deyaM sabiDakShAranAgaram||105||

+

</div></div>

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

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

+

नीलिनीं त्रिफलां रास्नां बलां कटुकरोहिणीम्|

Line 1,629: Line 1,880:

इति नीलिन्याद्यं घृतम्

+

nīlinīṁ triphalāṁ rāsnāṁ balāṁ kaṭukarōhiṇīm|

Line 1,665: Line 1,917:

iti nIlinyAdyaM ghRutam

+

</div></div>

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

Line 1,671: Line 1,924:

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

+

कुक्कुटाश्च मयूराश्च तित्तिरिक्रौञ्चवर्तकाः|

Line 1,679: Line 1,933:

समण्डवारुणीपानं पक्वं वा धान्यकैर्जलम्||१११||

+

kukkuṭāśca mayūrāśca tittirikrauñcavartakāḥ|

Line 1,695: Line 1,950:

samaNDavAruNIpAnaM pakvaM vA dhAnyakairjalam||111||

+

</div></div>

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

Line 1,701: Line 1,957:

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

+

मन्देऽग्नौ वर्धते गुल्मो दीप्ते चाग्नौ प्रशाम्यति|

तस्मान्ना नातिसौहित्यं कुर्यान्नातिविलङ्घनम्||११२||

+

mandē'gnau vardhatē gulmō dīptē cāgnau praśāmyati|

Line 1,713: Line 1,971:

tasmAnnA nAtisauhityaM kuryAnnAtivila~gghanam||112||

+

</div></div>

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]

==== Oleation therapy ====

+

सर्वत्र गुल्मे प्रथमं स्नेहस्वेदोपपादिते|

या क्रिया क्रियते सिद्धिं सा याति न विरूक्षिते||११३||

+

sarvatra gulmē prathamaṁ snēhasvēdōpapāditē|

Line 1,729: Line 1,990:

yA kriyA kriyate siddhiM sA yAti na virUkShite||113||

+

</div></div>

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

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

+

भिषगात्ययिकं बुद्ध्वा पित्तगुल्ममुपाचरेत्|

वैरेचनिकसिद्धेन सर्पिषा तिक्तकेन वा||११४||

+

bhiṣagātyayikaṁ buddhvā pittagulmamupācarēt|

Line 1,745: Line 2,009:

vairecanikasiddhena sarpiShA tiktakena [14] vA||114||

+

</div></div>

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

==== ''Rohiṇyadya ghritam'' ====

+

रोहिणीकटुकानिम्बमधुकत्रिफलात्वचः|

Line 1,763: Line 2,029:

इति रोहिण्याद्यं घृतम्

+

rōhiṇīkaṭukānimbamadhukatriphalātvacaḥ|

Line 1,791: Line 2,058:

iti rohiNyAdyaM ghRutam

+

</div></div>

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

==== ''Trayamaṇadi ghritam'' ====

+

जले दशगुणे साध्यं त्रायमाणाचतुष्पलम्|

Line 1,813: Line 2,082:

इति त्रायमाणाद्यं घृतम्

+

jalē daśaguṇē sādhyaṁ trāyamāṇācatuṣpalam|

Line 1,849: Line 2,119:

iti trAyamANAdyaM ghRutam

+

</div></div>

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

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

+

रसेनामलकेक्षूणां घृतपादं विपाचयेत्|

Line 1,859: Line 2,131:

इत्यामलकाद्यं घृतम्

+

rasēnāmalakēkṣūṇāṁ ghr̥tapādaṁ vipācayēt|

Line 1,871: Line 2,144:

ityAmalakAdyaM ghRutam

+

</div></div>

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]

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

+

द्राक्षां मधूकं खर्जूरं विदारीं सशतावरीम्|

Line 1,889: Line 2,164:

इति द्राक्षाद्यं घृतम्

+

drākṣāṁ madhūkaṁ kharjūraṁ vidārīṁ saśatāvarīm|

Line 1,917: Line 2,193:

iti drAkShAdyaM ghRutam

+

</div></div>

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

==== ''Vasaghr̥itam'' ====

+

वृषं समूलमापोथ्य पचेदष्टगुणे जले|

Line 1,931: Line 2,209:

इति वासाघृतम्

+

vr̥ṣaṁ samūlamāpōthya pacēdaṣṭaguṇē jalē|

Line 1,951: Line 2,230:

iti vAsAghRutam

+

</div></div>

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

+

द्विपलं त्रायमाणाया जलद्विप्रस्थसाधितम्|

Line 1,961: Line 2,242:

तेन निर्हृतदोषस्य गुल्मः शाम्यति पैत्तिकः||१२९||

+

dvipalaṁ trāyamāṇāyā jaladviprasthasādhitam|

Line 1,977: Line 2,259:

tena nirhRutadoShasya gulmaH shAmyati paittikaH||129||

+

</div></div>

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

+

द्राक्षाभयारसं गुल्मे पैत्तिके सगुडं पिबेत्|

लिह्यात्कम्पिल्लकं वाऽपि विरेकार्थं मधुद्रवम्||१३०||

+

drākṣābhayārasaṁ gulmē paittikē saguḍaṁ pibēt|

Line 1,991: Line 2,276:

lihyAtkampillakaM vA~api virekArthaM madhudravam||130||

+

</div></div>

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

==== Massage ====

+

दाहप्रशमनोऽभ्यङ्गः सर्पिषा पित्तगुल्मिनाम्|

चन्दनाद्येन तैलेन तैलेन मधुकस्य वा||१३१||

+

dāhapraśamanō'bhyaṅgaḥ sarpiṣā pittagulminām|

Line 2,007: Line 2,295:

candanAdyena tailena tailena madhukasya vA||131||

+

</div></div>

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

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

+

ये च पित्तज्वरहराः सतिक्ताः क्षीरबस्तयः|

हितास्ते पित्तगुल्मिभ्यो वक्ष्यन्ते ये च सिद्धिषु||१३२||

+

yē ca pittajvaraharāḥ satiktāḥ kṣīrabastayaḥ|

Line 2,023: Line 2,314:

hitAste pittagulmibhyo vakShyante ye ca siddhiShu||132||

+

</div></div>

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

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

+

शालयो जाङ्गलं मांसं गव्याजे पयसी घृतम्|

Line 2,035: Line 2,328:

बलाविदारीगन्धाद्यैः पित्तगुल्मचिकित्सितम्||१३४||

+

śālayō jāṅgalaṁ māṁsaṁ gavyājē payasī ghr̥tam|

Line 2,051: Line 2,345:

balAvidArIgandhAdyaiH pittagulmacikitsitam||134||

+

</div></div>

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

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

+

आमान्वये पित्तगुल्मे सामे वा कफवातिके|

यवागूभिः खडैर्यूषैः सन्धुक्ष्योऽग्निर्विलङ्घिते||१३५||

+

āmānvayē pittagulmē sāmē vā kaphavātikē|

Line 2,067: Line 2,364:

yavAgUbhiH khaDairyUShaiH sandhukShyo~agnirvila~gghite||135||

+

</div></div>

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

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

+

शमप्रकोपौ दोषाणां सर्वेषामग्निसंश्रितौ|

तस्मादग्निं सदा रक्षेन्निदानानि च वर्जयेत्||१३६||

+

śamaprakōpau dōṣāṇāṁ sarvēṣāmagnisaṁśritau|

Line 2,083: Line 2,383:

tasmAdagniM sadA rakShennidAnAni ca varjayet||136||

+

</div></div>

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

Line 2,089: Line 2,390:

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

+

वमनं वमनार्हाय प्रदद्यात् कफगुल्मिने|

+

vamanaṁ vamanārhāya pradadyāt kaphagulminē|

vamanaM vamanArhAya pradadyAt kaphagulmine|

+

</div></div>

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

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

+

स्निग्धस्विन्नशरीराय गुल्मे शैथिल्यमागते||१३७||

Line 2,113: Line 2,418:

मृद्नीयाद्गुल्ममेवैकं न त्वन्त्रहृदयं स्पृशेत्||१४०||

+

snigdhasvinnaśarīrāya gulmē śaithilyamāgatē||137||

Line 2,141: Line 2,447:

mRudnIyAdgulmamevaikaM na tvantrahRudayaM [19] spRushet||140||

+

</div></div>

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

Line 2,147: Line 2,454:

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

+

तिलैरण्डातसीबीजसर्षपैः परिलिप्य च|

श्लेष्मगुल्ममयःपात्रैः सुखोष्णैः स्वेदयेद्भिषक्||१४१||

+

tilairaṇḍātasībījasarṣapaiḥ parilipya ca|

Line 2,159: Line 2,468:

shleShmagulmamayaHpAtraiH sukhoShNaiH svedayedbhiShak||141||

+

</div></div>

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]

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

+

सव्योषक्षारलवणं दशमूलीशृतं घृतम्|

Line 2,169: Line 2,480:

इति दशमूलीघृतम्|

+

savyōṣakṣāralavaṇaṁ daśamūlīśr̥taṁ ghr̥tam|

Line 2,181: Line 2,493:

iti dashamUlIghRutam

+

</div></div>

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

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

+

भल्लातकानां द्विपलं पञ्चमूलं पलोन्मितम्|

Line 2,203: Line 2,517:

इति भल्लातकाद्यं घृतम्

+

bhallātakānāṁ dvipalaṁ pañcamūlaṁ palōnmitam|

Line 2,239: Line 2,554:

iti bhallAtakAdyaM ghRutam

+

</div></div>

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

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

+

पिप्पलीपिप्पलीमूलचव्यचित्रकनागरैः|

Line 2,253: Line 2,570:

इति क्षीरषट्पलकं घृतम्

+

pippalīpippalīmūlacavyacitrakanāgaraiḥ|

Line 2,273: Line 2,591:

iti kShIraShaTpalakaM ghRutam

+

</div></div>

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

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

+

त्रिवृतां त्रिफलां दन्तीं दशमूलं पलोन्मितम्|

Line 2,291: Line 2,611:

इति मिश्रकः स्नेहः

+

trivr̥tāṁ triphalāṁ dantīṁ daśamūlaṁ palōnmitam|

Line 2,319: Line 2,640:

iti mishrakaH snehaH

+

</div></div>

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

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

+

यदुक्तं वातगुल्मघ्नं स्रंसनं नीलिनीघृतम्|

Line 2,331: Line 2,654:

कार्षिकं मधुसर्पिभ्यां लीढ्वा साधु विरिच्यते||१५३||

+

yaduktaṁ vātagulmaghnaṁ sraṁsanaṁ nīlinīghr̥tam|

Line 2,347: Line 2,671:

kArShikaM madhusarpibhyAM lIDhvA [20] sAdhu viricyate||153||

+

</div></div>

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

Line 2,353: Line 2,678:

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

+

जलद्रोणे विपक्तव्या विंशतिः पञ्च चाभयाः|

Line 2,383: Line 2,709:

इति दन्तीहरीतकी

+

jaladrōṇē vipaktavyā viṁśatiḥ pañca cābhayāḥ|

Line 2,443: Line 2,770:

iti dantIharItakI

+

</div></div>

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

Line 2,449: Line 2,777:

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

+

सिद्धाः सिद्धिषु वक्ष्यन्ते निरूहाः कफगुल्मिनाम्|

अरिष्टयोगाः सिद्धाश्च ग्रहण्यर्शश्चिकित्सिते||१६१||

+

siddhāḥ siddhiṣu vakṣyantē nirūhāḥ kaphagulminām|

Line 2,461: Line 2,791:

ariShTayogAH siddhAshca grahaNyarshashcikitsite||161||

+

</div></div>

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

==== Powders and pills ====

+

यच्चूर्णं गुटिका याश्च विहिता वातगुल्मिनाम्|

द्विगुणक्षारहिङ्ग्वम्लवेतसास्ताः कफे हिताः||१६२||

+

yaccūrṇaṁ guṭikā yāśca vihitā vātagulminām|

Line 2,477: Line 2,810:

dviguNakShArahi~ggvamlavetasAstAH kaphe hitAH||162||

+

</div></div>

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

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

+

य एव ग्रहणीदोषे क्षारास्ते कफगुल्मिनाम्|

सिद्धा निरत्ययाः शस्ता दाहस्त्वन्ते प्रशस्यते||१६३||

+

ya ēva grahaṇīdōṣē kṣārāstē kaphagulminām|

Line 2,493: Line 2,829:

siddhA niratyayAH shastA dAhastvante prashasyate||163||

+

</div></div>

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

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

+

प्रपुराणानि धान्यानि जाङ्गला मृगपक्षिणः|

Line 2,505: Line 2,843:

चिरबिल्वाङ्कुराणां च यवान्याश्चित्रकस्य च||१६५||

+

prapurāṇāni dhānyāni jāṅgalā mr̥gapakṣiṇaḥ|

Line 2,521: Line 2,860:

cirabilvA~gkurANAM ca yavAnyAshcitrakasya ca||165||

+

</div></div>

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

+

बीजपूरकहिङ्ग्वम्लवेतसक्षारदाडिमैः|

तक्रेण तैलसर्पिर्भ्यां व्यञ्जनान्युपकल्पयेत्||१६६||

+

bījapūrakahiṅgvamlavētasakṣāradāḍimaiḥ|

Line 2,535: Line 2,877:

takreNa tailasarpirbhyAM vya~jjanAnyupakalpayet||166||

+

</div></div>

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

+

पञ्चमूलीशृतं तोयं पुराणं वारुणीरसम्|

कफगुल्मी पिबेत्काले जीर्णं माध्वीकमेव वा||१६७||

+

pañcamūlīśr̥taṁ tōyaṁ purāṇaṁ vāruṇīrasam|

Line 2,549: Line 2,894:

kaphagulmI pibetkAle jIrNaM mAdhvIkameva vA||167||

+

</div></div>

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

+

यवानीचूर्णितं तक्रं बिडेन लवणीकृतम्|

पिबेत् सन्दीपनं वातकफमूत्रानुलोमनम् ||१६८||

+

yavānīcūrṇitaṁ takraṁ biḍēna lavaṇīkr̥tam|

Line 2,563: Line 2,911:

pibet sandIpanaM vAtakaphamUtrAnulomanam [23] ||168||

+

</div></div>

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

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

+

सञ्चितः क्रमशो गुल्मो महावास्तुपरिग्रहः|

Line 2,575: Line 2,925:

तृष्णातन्द्राप्रतिश्यायैर्युज्यते न स सिध्यति||१७०||

+

sañcitaḥ kramaśō gulmō mahāvāstuparigrahaḥ|

Line 2,591: Line 2,942:

tRuShNAtandrApratishyAyairyujyate na sa sidhyati||170||

+

</div></div>

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]

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

+

गृहीत्वा सज्वरश्वासं वम्यतीसारपीडितम्|

हृन्नाभिहस्तपादेषु शोफः कर्षति गुल्मिनम्||१७१||

+

gr̥hītvā sajvaraśvāsaṁ vamyatīsārapīḍitam|

Line 2,607: Line 2,961:

hRunnAbhihastapAdeShu shophaH karShati gulminam||171||

+

</div></div>

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

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

+

रौधिरस्य तु गुल्मस्य गर्भकालव्यतिक्रमे|

स्निग्धस्विन्नशरीरायै दद्यात् स्नेहविरेचनम्||१७२||

+

raudhirasya tu gulmasya garbhakālavyatikramē|

Line 2,622: Line 2,979:

raudhirasya tu gulmasya garbhakAlavyatikrame|

snigdhasvinnasharIrAyai dadyAt snehavirecanam||172||

+

</div></div>

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

+

पलाशक्षारपात्रे द्वे द्वे पात्रे तैलसर्पिषोः|

गुल्मशैथिल्यजननीं पक्त्वा मात्रां प्रयोजयेत्||१७३||

+

palāśakṣārapātrē dvē dvē pātrē tailasarpiṣōḥ|

Line 2,636: Line 2,996:

gulmashaithilyajananIM paktvA mAtrAM prayojayet||173||

+

</div></div>

Make a semisolid preparation by heating 5 Kg of ''palasha-kshara'' with 5 kg each of ghee and oil. Administer it in sufficient dose to make the ''gulma'' soft/loose. [173]

+

प्रभिद्येत न यद्येवं दद्याद्योनिविशोधनम् |

Line 2,650: Line 3,012:

किण्वं वा सगुडक्षारं दद्याद्योनिविशोधनम्||१७६||

+

prabhidyēta na yadyēvaṁ dadyādyōniviśōdhanam |

Line 2,674: Line 3,037:

kiNvaM vA saguDakShAraM dadyAdyonivishodhanam||176||

+

</div></div>

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

Line 2,682: Line 3,046:

Or yeast mixed with jaggery and honey may be used for cleansing the vagina [174-176]

+

रक्तपित्तहरं क्षारं लेहयेन्मधुसर्पिषा|

लशुनं मदिरां तीक्ष्णां मत्स्यांश्चास्यै प्रदापयेत्||१७७||

+

raktapittaharaṁ kṣāraṁ lēhayēnmadhusarpiṣā|

Line 2,694: Line 3,060:

lashunaM madirAM tIkShNAM matsyAMshcAsyai pradApayet||177||

+

</div></div>

''Kshara'' which cures ''raktapitta'' may be licked with honey and ghee. Or garlic mixed with strong wine and fish may be given in diet [177]

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बस्तिं सक्षीरगोमूत्रं सक्षारं दाशमूलिकम्|

अदृश्यमाने रुधिरे दद्याद्गुल्मप्रभेदनम्||१७८||

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bastiṁ sakṣīragōmūtraṁ sakṣāraṁ dāśamūlikam|

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adRushyamAne rudhire dadyAdgulmaprabhedanam||178||

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</div></div>

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

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प्रवर्तमाने रुधिरे दद्यान्मांसरसौदनम्|

घृततैलेन चाभ्यङ्गं पानार्थं तरुणीं सुराम्||१७९||

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pravartamānē rudhirē dadyānmāṁsarasaudanam|

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ghRutatailena cAbhya~ggaM pAnArthaM taruNIM surAm||179||

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</div></div>

When blood starts flowing through vagina then rice with meat soup should be given to eat. Massage with ghee or oil is done and for drink new wine may be given [179]

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रुधिरेऽतिप्रवृत्ते तु रक्तपित्तहरीः क्रियाः|

कार्या वातरुगार्तायाः सर्वा वातहरीः पुनः||१८०||

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rudhirē'tipravr̥ttē tu raktapittaharīḥ kriyāḥ|

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kAryA vAtarugArtAyAH sarvA vAtaharIH punaH||180||

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</div></div>

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

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घृततैलावसेकांश्च तित्तिरींश्चरणायुधान्|

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अतिप्रवृत्ते रुधिरे सतिक्तेनानुवासनम्||१८२||

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ghr̥tatailāvasēkāṁśca tittirīṁścaraṇāyudhān|

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atipravRutte rudhire satiktenAnuvAsanam||182||

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</div></div>

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

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==== Summary ====

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तत्र श्लोकाः-

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गुल्मचिकित्सितसङ्ग्रह एतावान् व्याहृतोऽग्निवेशस्य||१८९||

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tatra ślōkāḥ-

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gulmacikitsitasa~ggraha etAvAn vyAhRuto~agniveshasya||189||

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</div></div>

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

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

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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते चिकित्सितस्थाने

गुल्मचिकित्सितं नाम पञ्चमोऽध्यायः||५||

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ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsitasthānē

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gulmacikitsitaM nAma pa~jcamo~adhyAyaH||5||

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</div></div>

Thus fifth chapter named [[Gulma Chikitsa]] in [[Chikitsa Sthana]] in the treatise compiled by Agnivesha and revised by Charak is completed [5]

Agnivesha

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