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Line 331: − + − + + + + + + − In [[Chikitsa Sthana]], Charaka states that vata gets vitiated by two basic means i.e. dhatukshaya (tissue wasting) and margavarana (obstruction). The etiology given in this chapter could also include excess consumption of food with ruksha guna, trauma and faulty shodhana procedures, excessive loss of mala and dhatu responsible for dhatukshaya and various other factors that vitiate doshas and mala causing obstruction of different channels, further aggravating vata. − 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. Also, in the absence of any dushya (dhatu and mala), these swellings are commonly non-suppurative in nature. There are, however, some cases where suppuration may take place. For example, in Chikitsasthana, Charaka has mentioned that suppuration may takes place in pittaja gulma and further elaborates the various stages of suppuration of gulma i.e. ama (immature or initial stage), pachyamana (intermediary stage) and pakwa awastha (final mature stage) etc. similar to the stages seen in various suppurative conditions like vidradhi. Chakrapani commented that when the pittagulma is not treated timely, pitta dosha and rakta dhatu get aggravated (together or separately), and involves the deeper structure (kritmulam). − Shadkriyakala (lifecycle) of Gulma:
→Etiopathogenesis of gulma
A comprehensive effort has been made in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] to describe different types of swellings occurring in the body e.g. ''gulma, udara roga, vriddhi roga, granthi, arbuddha, shopha,'' and ''vidradhi'' etc. They can be distinguished from each other according to their specific characteristics as written in different classics of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. Generalized abdominal swellings have been described under the heading of ''udara roga'' (abdominal diseases including ascitis), while localized, non-suppurated swellings are ''gulmas''. Other localized swellings, such as ''vriddhi roga'' (hernia and hydrocele), have also been described by ancient authors but such swellings are in regions other than the gastro-intestinal region, or in parts of the body such as the scrotal and inguinoscrotal region. ''Shopha'' is a localized inflammatory swelling. ''Vidradhi'' (abscess) are also localized but large suppurative lesions and are deep - rooted that may develop either from external surfaces or internal body cavities. ''Granthi'' (cyst) and ''arbuda'' (tumor) are also localised, progressively increasing knotty lesions and are primarily non suppurative in nature. Such swellings may arise in any part of the body and are commonly known as neoplastic lesions.
A comprehensive effort has been made in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] to describe different types of swellings occurring in the body e.g. ''gulma, udara roga, vriddhi roga, granthi, arbuddha, shopha,'' and ''vidradhi'' etc. They can be distinguished from each other according to their specific characteristics as written in different classics of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. Generalized abdominal swellings have been described under the heading of ''udara roga'' (abdominal diseases including ascitis), while localized, non-suppurated swellings are ''gulmas''. Other localized swellings, such as ''vriddhi roga'' (hernia and hydrocele), have also been described by ancient authors but such swellings are in regions other than the gastro-intestinal region, or in parts of the body such as the scrotal and inguinoscrotal region. ''Shopha'' is a localized inflammatory swelling. ''Vidradhi'' (abscess) are also localized but large suppurative lesions and are deep - rooted that may develop either from external surfaces or internal body cavities. ''Granthi'' (cyst) and ''arbuda'' (tumor) are also localised, progressively increasing knotty lesions and are primarily non suppurative in nature. Such swellings may arise in any part of the body and are commonly known as neoplastic lesions.
==== Etiopathogenesis of gulma ====
==== Etiopathogenesis of ''gulma'' ====
In [[Charaka Samhita]], vitiated vata dosha is considered as major aetiological factor for the development of any type of gulma. . Amongst the five types of vata mentioned in [[Charaka Samhita]], vitiated apana and/or samana vata seem to be the primary etiological factors of gulma, since these are mainly responsible for the normal physiological functions of mahastrotas. The prodromal symptoms of gulma also point towards these two e.g. aversion to food, anorexia, and diminished urge to pass flatus, urine and feces.
In [[Charaka Samhita]], vitiated ''vata dosha'' is considered as major aetiological factor for the development of any type of ''gulma''. Amongst the five types of ''vata'' mentioned in [[Charaka Samhita]], vitiated ''apana'' and/or ''samana vata'' seem to be the primary etiological factors of ''gulma'', since these are mainly responsible for the normal physiological functions of ''mahastrotas''. The prodromal symptoms of ''gulma'' also point towards these two e.g. aversion to food, anorexia, and diminished urge to pass flatus, urine and feces.
In [[Chikitsa Sthana]], Charaka states that ''vata'' gets vitiated by two basic means i.e. ''dhatukshaya'' (tissue wasting) and ''margavarana'' (obstruction). The etiology given in this chapter could also include excess consumption of food with ''ruksha guna'', trauma and faulty ''shodhana'' procedures, excessive loss of ''mala'' and ''dhatu'' responsible for ''dhatukshaya'' and various other factors that vitiate ''doshas'' and ''mala'' causing obstruction of different channels, further aggravating ''vata''.
While analyzing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''doshas'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''doshas'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear. Also, in the absence of any ''dushya'' (''dhatu'' and ''mala''), these swellings are commonly non-suppurative in nature. There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charaka has mentioned that suppuration may takes place in ''pittaja'' ''gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), pachyamana (intermediary stage) and pakwa awastha (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''pitta gulma'' is not treated timely, ''pitta dosha'' and ''rakta dhatu'' get aggravated (together or separately), and involves the deeper structure (kritmulam).
''shadkriyakala'' (lifecycle) of ''gulma'':
a. 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.
a. 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.