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=== Abstract ===

=== Abstract ===

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

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

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

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

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

=== Introduction ===

=== Introduction ===

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

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

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

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

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

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

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

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